1164931267 NPI number — YOSELINE PATRICIA GONZALEZ SLP

Table of content: YOSELINE PATRICIA GONZALEZ SLP (NPI 1164931267)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164931267 NPI number — YOSELINE PATRICIA GONZALEZ SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GONZALEZ
Provider First Name:
YOSELINE
Provider Middle Name:
PATRICIA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
SLP
Provider Gender Code:
F

Provider's Other Name Information

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

NPI Number Information

NPI Number:
1164931267
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/21/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
FM 886 S PALO BLANCO ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SULLIVAN CITY
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78595
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
956-580-9911
Provider Business Mailing Address Fax Number:
956-580-8257

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1715 EXPRESSWAY 83 STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PENITAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78576-8335
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-580-9911
Provider Business Practice Location Address Fax Number:
956-580-8257
Provider Enumeration Date:
09/21/2017

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: 235Z00000X , with the licence number:  112793 , 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)





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