Provider Demographics
NPI:1043861925
Name:GONZALEZ, MARIA LOURDES
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:LOURDES
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1549 PRADO DEL SOL DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-6205
Mailing Address - Country:US
Mailing Address - Phone:915-256-4980
Mailing Address - Fax:
Practice Address - Street 1:1549 PRADO DEL SOL DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-6205
Practice Address - Country:US
Practice Address - Phone:915-256-4980
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-23
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider