Provider Demographics
NPI:1003344474
Name:GONZALEZ VADELL, EDUARDO (LSA)
Entity Type:Individual
Prefix:
First Name:EDUARDO
Middle Name:
Last Name:GONZALEZ VADELL
Suffix:
Gender:M
Credentials:LSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18756 STONE OAK PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-4354
Mailing Address - Country:US
Mailing Address - Phone:210-998-5527
Mailing Address - Fax:210-579-8601
Practice Address - Street 1:18756 STONE OAK PKWY STE 200
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-4354
Practice Address - Country:US
Practice Address - Phone:210-998-5527
Practice Address - Fax:210-579-8601
Is Sole Proprietor?:No
Enumeration Date:2017-05-30
Last Update Date:2019-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17-247246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant