MEDICARE: CLARISA 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	171400000X	Health & Wellness Coach
2	261QH0100X	Health Service Clinic/Center

General Provider Information

NPI Number	:	1346016524
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLARISA GONZALEZ

Provider Business Mailing Address
First Line	:	1111 N 10TH ST STE D
Second Line	:
City	:	MCALLEN
State	:	TX
Zip	:	78501-4307
Country	:	US
Telephone Number	:	956-680-0267
Fax Number	:	956-627-3558

Provider Business Practice Location Address
First Line	:	1111 N 10TH ST STE D
Second Line	:
City	:	MCALLEN
State	:	TX
Zip	:	78501-4307
Country	:	US
Telephone Number	:	956-680-0267
Fax Number	:	956-627-3558

Authorized Official
Title or Position	:	LICE TECHNICIAN
Name	:	CLARISA GONZALEZ
Credential	:
Telephone Number	:	956-680-0267

Provider Enumeration Date	:	11/29/2023
Last Update Date	:	04/08/2026

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