Healthcare Provider Details

I. General information

NPI: 1083984793
Provider Name (Legal Business Name): VINCENT GONZALES LSA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2012
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 DEWLIGHT PL
THE WOODLANDS TX
77354-3361
US

IV. Provider business mailing address

3 DEWLIGHT PL
THE WOODLANDS TX
77354-3361
US

V. Phone/Fax

Practice location:
  • Phone: 281-653-2924
  • Fax: 832-688-8144
Mailing address:
  • Phone: 281-653-2924
  • Fax: 832-688-8144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License NumberSA00666
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: