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General NPI Number Information
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NPI Number | 1861090243
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Entity Type | Organization
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Legal Business Name | RIDGEWOOD PSYCHIATRY PLLC
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Dates
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Enumeration Date | 10/16/2020
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Last Update Date | 10/16/2020
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Provider Practice Location Address
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Address Line | 832 RIDGEWOOD ST
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City | BROWNSVILLE
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State | TX
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Zip | 78520
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Country | US
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Telephone | 956-479-3004
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 4270
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City | BROWNSVILLE
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State | TX
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Zip | 78523-4270
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Country | US
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Telephone | 956-479-3004
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MERLITA GONZALEZ
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Credential | MD
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Telephone | 956-479-3004
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number |
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License Number State |
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