MEDICARE: ROBERTA ANN GONZALEZ FNP-C

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	363LF0000X	Family Nurse Practitioner	250375	TX

General Provider Information

NPI Number	:	1669819108
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERTA ANN GONZALEZ FNP-C

Provider Business Mailing Address
First Line	:	10555 VISTA DEL SOL DR
Second Line	:	SUITE 200
City	:	EL PASO
State	:	TX
Zip	:	79925-7942
Country	:	US
Telephone Number	:	915-594-1033
Fax Number	:	915-594-1263

Provider Business Practice Location Address
First Line	:	10555 VISTA DEL SOL DR
Second Line	:	SUITE 200
City	:	EL PASO
State	:	TX
Zip	:	79925-7942
Country	:	US
Telephone Number	:	915-594-1033
Fax Number	:	915-594-1263

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

Provider Enumeration Date	:	05/23/2013
Last Update Date	:	05/23/2013

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