Healthcare Provider Details

I. General information

NPI: 1063020238
Provider Name (Legal Business Name): NORMA J GONZALEZ RD, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2020
Last Update Date: 07/14/2020
Certification Date: 07/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1426 KINGWOOD DR
KINGWOOD TX
77339-3040
US

IV. Provider business mailing address

32011 WILLOW CREEK PARK
CONROE TX
77385-8007
US

V. Phone/Fax

Practice location:
  • Phone: 800-424-6589
  • Fax:
Mailing address:
  • Phone: 281-620-3319
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License NumberDT06024
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: