1548449051 NPI number — BLANCA A. GONZALEZ

Table of content: (NPI 1548449051)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548449051 NPI number — BLANCA A. GONZALEZ

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BLANCA A. GONZALEZ
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1548449051
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/30/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
911 N SIGRID AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HEBBRONVILLE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78361-2337
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
956-220-6140
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1007 W VIGGIE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HEBBRONVILLE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78361-2363
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
361-527-3153
Provider Business Practice Location Address Fax Number:
361-527-3133
Provider Enumeration Date:
10/31/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GONZALEZ
Authorized Official First Name:
BLANCA
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
OWNER/ACTIVITY DIRECTOR
Authorized Official Telephone Number:
361-527-3153

Provider Taxonomy Codes

  • Taxonomy code: 311ZA0620X , with the licence number:  121520 , 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)





Copyright © 2007-2025 www.npivalidator.com