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General NPI Number Information
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NPI Number | 1558398420
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Entity Type | Individual
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Provider Name | DIANA GONZALEZ O.D.
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Gender | Female
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Dates
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Enumeration Date | 06/27/2006
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Last Update Date | 02/14/2024
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Provider Practice Location Address
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Address Line | 21126 MARKET RDG
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City | SAN ANTONIO
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State | TX
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Zip | 78258-4984
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Country | US
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Telephone | 210-305-5555
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Fax | 210-402-5435
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Provider Business Mailing Address
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Address Line | 21126 MARKET RDG
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City | SAN ANTONIO
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State | TX
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Zip | 78258-4984
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Country | US
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Telephone | 210-305-5555
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Fax | 210-402-5435
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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 | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 5906TG
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License Number State | TX
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