MEDICARE: DEBORAH M. GONZALEZ BA

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	103G00000X	Clinical Neuropsychologist	024006-01	NY
2	103G00000X	Clinical Neuropsychologist	39220	TX

General Provider Information

NPI Number	:	1609047299
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBORAH M. GONZALEZ BA

Provider Business Mailing Address
First Line	:	PO BOX 845347
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75284-5347
Country	:	US
Telephone Number	:	214-645-0624
Fax Number	:	214-645-0078

Provider Business Practice Location Address
First Line	:	1440 EMPIRE CENTRAL DR
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75247-4091
Country	:	US
Telephone Number	:	214-648-4646
Fax Number	:	214-648-4660

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

Provider Enumeration Date	:	03/21/2008
Last Update Date	:	03/14/2023

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