Provider Demographics
NPI:1033884754
Name:GONZALEZ, MARIA YESENIA
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:YESENIA
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 1:324 TRAMMEL RD
Mailing Address - Street 2:
Mailing Address - City:EDDY
Mailing Address - State:TX
Mailing Address - Zip Code:76524-3937
Mailing Address - Country:US
Mailing Address - Phone:254-624-7644
Mailing Address - Fax:
Practice Address - Street 1:763 MARLANDWOOD RD
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76502-3573
Practice Address - Country:US
Practice Address - Phone:254-771-5950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-13
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX216574224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant