MEDICARE: MRS. ANA JACKSON GONZALEZ M.S., R.D.,C.D.E.

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	133V00000X	Registered Dietitian	DT02660	TX

General Provider Information

NPI Number	:	1841456258
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANA JACKSON GONZALEZ M.S., R.D.,C.D.E.

Provider Business Mailing Address
First Line	:	1508 N WASHINGTON ST
Second Line	:
City	:	RIO GRANDE CITY
State	:	TX
Zip	:	78582-2538
Country	:	US
Telephone Number	:	956-487-8458
Fax Number	:	956-487-8458

Provider Business Practice Location Address
First Line	:	1508 N WASHINGTON ST
Second Line	:
City	:	RIO GRANDE CITY
State	:	TX
Zip	:	78582-2538
Country	:	US
Telephone Number	:	956-487-8458
Fax Number	:	956-487-8458

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

Provider Enumeration Date	:	08/05/2008
Last Update Date	:	08/05/2008

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