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NPI Code Detail

MEDICARE: DAVID EDWARDO GONZALEZ

MEDICARE: DAVID EDWARDO 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
1225200000XPhysical Therapy Assistant2134769TX

General Provider Information

NPI Number : 1801360326
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAVID EDWARDO GONZALEZ
Provider Business Mailing Address
First Line : 2106 BEVINGTON OAKS CIR
Second Line :
City : KATY
State : TX
Zip : 77450-6033
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 401 E BLUE BELL RD
Second Line :
City : BRENHAM
State : TX
Zip : 77833-2407
Country : US
Telephone Number : 979-836-6611
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/17/2019
Last Update Date : 01/17/2019

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Directions to “ DAVID EDWARDO GONZALEZ ” Practice Location

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