=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023312055
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AURORA GONZALEZ MD PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/05/2011
-----------------------------------------------------
Last Update Date | 10/06/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6410 FANNIN ST SUITE 1200
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77030-3000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-757-9905
-----------------------------------------------------
Fax | 713-757-7952
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6410 FANNIN ST SUITE 1200
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77030-3000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-757-9905
-----------------------------------------------------
Fax | 713-757-7952
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | AURORA GONZALEZ
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 713-757-9905
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | K6762
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------