1548563554 NPI number — MR. ANTONIO ALBERTO GONZALEZ LBSW

Table of content: MR. ANTONIO ALBERTO GONZALEZ LBSW (NPI 1548563554)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548563554 NPI number — MR. ANTONIO ALBERTO GONZALEZ LBSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GONZALEZ
Provider First Name:
ANTONIO
Provider Middle Name:
ALBERTO
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LBSW
Provider Gender Code:
M

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:
1548563554
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/13/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4318 TWIN CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EDINBURG
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78542-7114
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
956-789-8081
Provider Business Mailing Address Fax Number:
956-467-1075

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
712 LINDBERG AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MCALLEN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78501-2928
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-720-0684
Provider Business Practice Location Address Fax Number:
956-467-1075
Provider Enumeration Date:
12/13/2010

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: 104100000X , with the licence number:  54452 , 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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