MEDICARE: SANDRA A GONZALEZ FNP

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	AP119843	TX
2	163W00000X	Registered Nurse	718237	TX

General Provider Information

NPI Number	:	1881999175
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDRA A GONZALEZ FNP

Provider Business Mailing Address
First Line	:	PO BOX 66308
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77266-6308
Country	:	US
Telephone Number	:	832-548-5000
Fax Number	:

Provider Business Practice Location Address
First Line	:	9636 MESA DR
Second Line	:	KIPP BUILDING 9618
City	:	HOUSTON
State	:	TX
Zip	:	77078-3024
Country	:	US
Telephone Number	:	281-628-2050
Fax Number	:

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

Provider Enumeration Date	:	01/18/2011
Last Update Date	:	10/22/2015

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