MEDICARE: MRS. CORINA GONZALEZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	36864	TX

General Provider Information

NPI Number	:	1124108766
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CORINA GONZALEZ

Provider Business Mailing Address
First Line	:	2335 E SAUNDERS ST
Second Line	:	SUITE 2
City	:	LAREDO
State	:	TX
Zip	:	78041-5434
Country	:	US
Telephone Number	:	956-791-4800
Fax Number	:	956-791-4422

Provider Business Practice Location Address
First Line	:	2335 E SAUNDERS ST
Second Line	:	SUITE 2
City	:	LAREDO
State	:	TX
Zip	:	78041-5434
Country	:	US
Telephone Number	:	956-791-4800
Fax Number	:	956-791-4422

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/17/2006
Last Update Date	:	07/09/2007

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