MEDICARE: DR. VICTORIA ELIZABETH GONZALES MD

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	208000000X	Pediatrics Physician	U1279	TX

General Provider Information

NPI Number	:	1699331025
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VICTORIA ELIZABETH GONZALES MD

Provider Business Mailing Address
First Line	:	12377 MERIT DR STE 300
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75251-3126
Country	:	US
Telephone Number	:	972-957-3000
Fax Number	:

Provider Business Practice Location Address
First Line	:	2316 SE MILITARY DR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78223-3527
Country	:	US
Telephone Number	:	210-817-7004
Fax Number	:

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

Provider Enumeration Date	:	05/10/2019
Last Update Date	:	03/22/2023

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