Healthcare Provider Details

I. General information

NPI: 1508530726
Provider Name (Legal Business Name): RICHARD RAUL GONZALEZ RD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2021
Last Update Date: 10/22/2024
Certification Date: 10/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7207 BIRCH STAGE
SAN ANTONIO TX
78244-2340
US

IV. Provider business mailing address

7207 BIRCH STAGE
SAN ANTONIO TX
78244-2340
US

V. Phone/Fax

Practice location:
  • Phone: 210-860-2124
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License NumberDT85741
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code133VN1201X
TaxonomyObesity and Weight Management Nutrition Registered Dietitian
License NumberDT85741
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code133VN1501X
TaxonomySports Dietetics Nutrition Registered Dietitian
License NumberDT85741
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDT85741
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: