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General NPI Number Information
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NPI Number | 1982058053
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Entity Type | Individual
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Provider Name | EDGARDO MAURICIO GONZALEZ CSA, LSA
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Gender | Male
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Dates
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Enumeration Date | 04/14/2016
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Last Update Date | 12/05/2023
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Provider Practice Location Address
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Address Line | 17201 INTERSTATE 45 S
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City | SHENANDOAH
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State | TX
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Zip | 77385-3311
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Country | US
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Telephone | 305-610-0506
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Fax |
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Provider Business Mailing Address
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Address Line | 34 CHESWOOD MANOR DR
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City | THE WOODLANDS
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State | TX
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Zip | 77382-5380
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Country | US
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Telephone | 305-610-0506
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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 | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 246ZC0007X
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Taxonomy Name | Surgical Assistant
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License Number | 16-165
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License Number State | WI
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