Healthcare Provider Details

I. General information

NPI: 1558573980
Provider Name (Legal Business Name): MONICA V GONZALES MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2007
Last Update Date: 06/04/2020
Certification Date: 06/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3551 ROGER BROOKE DR
JBSA FT SAM HOUSTON TX
78234-4504
US

IV. Provider business mailing address

26445 E WALKER DR
AURORA CO
80016-6104
US

V. Phone/Fax

Practice location:
  • Phone: 210-916-3000
  • Fax: 303-436-4665
Mailing address:
  • Phone: 210-454-8276
  • Fax: 303-627-1418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberM5727
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: