Healthcare Provider Details

I. General information

NPI: 1801089941
Provider Name (Legal Business Name): AIXA GONZALEZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: AIXA PEREZ

II. Dates (important events)

Enumeration Date: 08/22/2007
Last Update Date: 10/27/2023
Certification Date: 10/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9939 HIGHWAY 151
SAN ANTONIO TX
78251-1900
US

IV. Provider business mailing address

104 MARK DR
EDENTON NC
27932-1756
US

V. Phone/Fax

Practice location:
  • Phone: 210-706-7800
  • Fax: 210-949-9581
Mailing address:
  • Phone: 252-482-5171
  • Fax: 252-809-5172

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25202
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2016-00990
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: