1114937216 NPI number — MARIAELENA GONZALEZ-SOZER M.D.

Table of content: MARIAELENA GONZALEZ-SOZER M.D. (NPI 1114937216)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114937216 NPI number — MARIAELENA GONZALEZ-SOZER M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GONZALEZ-SOZER
Provider First Name:
MARIAELENA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GONZALEZ
Provider Other First Name:
MARIAELENA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1114937216
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/30/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5959 GATEWAY BLVD W
Provider Second Line Business Mailing Address:
STE. 120
Provider Business Mailing Address City Name:
EL PASO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79925-3331
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
915-779-1716
Provider Business Mailing Address Fax Number:
915-771-6558

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
125 W HAGUE RD
Provider Second Line Business Practice Location Address:
STE.110
Provider Business Practice Location Address City Name:
EL PASO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79902-5814
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
915-351-7644
Provider Business Practice Location Address Fax Number:
915-351-2928
Provider Enumeration Date:
08/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  K4904 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0014HL . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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