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General NPI Number Information
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NPI Number | 1487266961
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Entity Type | Individual
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Provider Name | NOE GONZALEZ
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Gender | Male
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Dates
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Enumeration Date | 08/17/2020
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Last Update Date | 08/17/2020
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Provider Practice Location Address
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Address Line | 208 STARR ST STE 2
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City | MERCEDES
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State | TX
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Zip | 78570-2736
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Country | US
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Telephone | 956-514-1551
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Fax |
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Provider Business Mailing Address
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Address Line | 905 EL CAMPO DR
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City | SAN JUAN
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State | TX
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Zip | 78589-3834
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Country | US
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Telephone | 956-867-1018
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 120975
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License Number State | TX
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