Provider Demographics
NPI:1003090804
Name:GONZALEZ, DAVID V
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:V
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3110 HILLCREST DR
Mailing Address - Street 2:APT # 607
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78201-7055
Mailing Address - Country:US
Mailing Address - Phone:210-381-0680
Mailing Address - Fax:
Practice Address - Street 1:3110 HILLCREST DR
Practice Address - Street 2:APT # 607
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78201-7055
Practice Address - Country:US
Practice Address - Phone:210-381-0680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-28
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA05930404450246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy