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General NPI Number Information
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NPI Number | 1912121831
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Entity Type | Organization
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Legal Business Name | PENELOPE GONZALEZ MD PA
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Dates
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Enumeration Date | 04/12/2007
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Last Update Date | 11/17/2009
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Provider Practice Location Address
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Address Line | 6624 FANNIN ST STE 2250
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City | HOUSTON
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State | TX
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Zip | 77030-2308
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Country | US
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Telephone | 713-790-0003
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Fax | 713-797-9821
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Provider Business Mailing Address
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Address Line | PO BOX 25124
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City | HOUSTON
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State | TX
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Zip | 77265-5124
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Country | US
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Telephone | 713-256-8198
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Fax | 713-666-8232
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Authorized Official
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Title or Position | SOLE PROPRIETOR
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Name | DR. PENELOPE GONZALEZ
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Credential | MD
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Telephone | 713-256-8198
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | L6402
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License Number State | TX
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