Healthcare Provider Details

I. General information

NPI: 1629754882
Provider Name (Legal Business Name): LAMAR GONZALEZ ACEVEDO APRN, A-GNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2023
Last Update Date: 07/11/2023
Certification Date: 07/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

702 E CALTON RD
LAREDO TX
78041-3988
US

IV. Provider business mailing address

1620 LANE ST
LAREDO TX
78043-2617
US

V. Phone/Fax

Practice location:
  • Phone: 956-728-8255
  • Fax: 956-728-0400
Mailing address:
  • Phone: 956-285-5593
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1128162
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: