MEDICARE: PENELOPE GONZALEZ MD PA

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	207R00000X	Internal Medicine Physician	L6402	TX

General Provider Information

NPI Number	:	1912121831
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PENELOPE GONZALEZ MD PA

Provider Business Mailing Address
First Line	:	PO BOX 25124
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77265-5124
Country	:	US
Telephone Number	:	713-256-8198
Fax Number	:	713-666-8232

Provider Business Practice Location Address
First Line	:	6624 FANNIN ST STE 2250
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-2308
Country	:	US
Telephone Number	:	713-790-0003
Fax Number	:	713-797-9821

Authorized Official
Title or Position	:	SOLE PROPRIETOR
Name	:	DR. PENELOPE GONZALEZ
Credential	:	MD
Telephone Number	:	713-256-8198

Provider Enumeration Date	:	04/12/2007
Last Update Date	:	11/17/2009

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