Healthcare Provider Details

I. General information

NPI: 1518155134
Provider Name (Legal Business Name): NYDIA GONZALEZ RN, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2007
Last Update Date: 11/29/2021
Certification Date: 11/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

603 E AMBER ST STE 101
SAN ANTONIO TX
78221-2456
US

IV. Provider business mailing address

603 E AMBER ST STE 101
SAN ANTONIO TX
78221-2456
US

V. Phone/Fax

Practice location:
  • Phone: 210-610-7283
  • Fax: 210-812-5938
Mailing address:
  • Phone: 210-610-7283
  • Fax: 210-812-5938

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP115868
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: