Healthcare Provider Details

I. General information

NPI: 1346963055
Provider Name (Legal Business Name): JOSEPHINE GONZALEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2022
Last Update Date: 09/19/2022
Certification Date: 09/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7410 BLANCO RD
SAN ANTONIO TX
78216-4363
US

IV. Provider business mailing address

11054 ALMOND PARK
SAN ANTONIO TX
78249-4223
US

V. Phone/Fax

Practice location:
  • Phone: 210-838-5351
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number113620
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: