Healthcare Provider Details

I. General information

NPI: 1346016524
Provider Name (Legal Business Name): CLARISA GONZALEZ
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2023
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1217 ERIE AVE
MCALLEN TX
78501-4907
US

IV. Provider business mailing address

1217 ERIE AVE
MCALLEN TX
78501-4907
US

V. Phone/Fax

Practice location:
  • Phone: 956-680-0267
  • Fax: 956-627-3558
Mailing address:
  • Phone: 956-680-0267
  • Fax: 956-627-3558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CLARISA GONZALEZ
Title or Position: TECHNICIAN
Credential:
Phone: 956-680-0267