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NPI Code Detail

MEDICARE: JUAN MANUEL GONZALEZ CRNA

MEDICARE: JUAN MANUEL GONZALEZ CRNA
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
1367500000XCertified Registered Nurse Anesthetist677738TX
2367500000XCertified Registered Nurse AnesthetistAP111476TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
189806UOTHERTXBCBS

General Provider Information

NPI Number : 1235193350
Entity Type Code : Individual
Provider Name (Legal Business Name) : JUAN MANUEL GONZALEZ CRNA
Provider Business Mailing Address
First Line : PO BOX 100145
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78201-1445
Country : US
Telephone Number : 833-922-1084
Fax Number :
Provider Business Practice Location Address
First Line : 3333 N FOSTER MALDONADO BLVD
Second Line :
City : EAGLE PASS
State : TX
Zip : 78852-5893
Country : US
Telephone Number : 830-773-5321
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/14/2006
Last Update Date : 11/30/2022

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