Healthcare Provider Details

I. General information

NPI: 1780717595
Provider Name (Legal Business Name): ANNIKA MARIE GONZALEZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 12/05/2024
Certification Date: 12/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3503 PAESANOS PKWY STE 101
SAN ANTONIO TX
78231-1225
US

IV. Provider business mailing address

3503 PAESANOS PKWY STE 101
SAN ANTONIO TX
78231-1225
US

V. Phone/Fax

Practice location:
  • Phone: 210-492-8922
  • Fax: 210-479-2010
Mailing address:
  • Phone: 210-492-8922
  • Fax: 210-479-2010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberM6150
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: