Healthcare Provider Details

I. General information

NPI: 1518848076
Provider Name (Legal Business Name): ROSALBA PENA GONZALEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2025
Last Update Date: 09/10/2025
Certification Date: 09/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8910 BREEZEFIELD
SAN ANTONIO TX
78240-5446
US

IV. Provider business mailing address

PO BOX 690066
SAN ANTONIO TX
78269-0066
US

V. Phone/Fax

Practice location:
  • Phone: 512-210-9583
  • Fax:
Mailing address:
  • Phone: 512-210-9583
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171R00000X
TaxonomyInterpreter
License Number
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: