Healthcare Provider Details

I. General information

NPI: 1710593330
Provider Name (Legal Business Name): YANEXIS PLAZA GONZALEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2020
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6402 S GLENROCK HILLS CT
KATY TX
77494-0444
US

IV. Provider business mailing address

1155 DAIRY ASHFORD RD
HOUSTON TX
77079-3021
US

V. Phone/Fax

Practice location:
  • Phone: 562-319-3280
  • Fax:
Mailing address:
  • Phone: 713-799-2200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1006005
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number795532
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: