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General NPI Number Information
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NPI Number | 1548436686
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Entity Type | Organization
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Legal Business Name | JOHN & PATRICIA GONZALES
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Dates
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Enumeration Date | 05/07/2008
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Last Update Date | 10/14/2015
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Provider Practice Location Address
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Address Line | 701 N MAIN ST
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City | DONNA
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State | TX
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Zip | 78537-2765
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Country | US
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Telephone | 956-464-3649
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Fax | 956-464-3670
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Provider Business Mailing Address
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Address Line | 701 N MAIN ST SUITE B
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City | DONNA
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State | TX
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Zip | 78537-2765
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Country | US
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Telephone | 956-464-3649
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Fax | 956-464-3670
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | MR. JERRY F. CASTILLEJA
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Credential | M.D.
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Telephone | 956-464-3649
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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