Healthcare Provider Details

I. General information

NPI: 1508051343
Provider Name (Legal Business Name): ESMERALDA E GONZALEZ M.A., CCC/SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2007
Last Update Date: 02/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

702 GALVESTON ST
LAREDO TX
78040-4638
US

IV. Provider business mailing address

2105 LIMA LOOP
LAREDO TX
78045-6420
US

V. Phone/Fax

Practice location:
  • Phone: 956-568-4571
  • Fax: 956-568-4671
Mailing address:
  • Phone: 956-723-1309
  • Fax: 956-568-4671

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number100691
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: