Provider Demographics
NPI:1043914989
Name:GONZALEZ, ARACELY
Entity Type:Individual
Prefix:
First Name:ARACELY
Middle Name:
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 1:302 EAST BUSINESS HIGHWAY 83
Mailing Address - Street 2:STE 4 & 5
Mailing Address - City:SAN JUAN
Mailing Address - State:TX
Mailing Address - Zip Code:78589
Mailing Address - Country:US
Mailing Address - Phone:956-575-7525
Mailing Address - Fax:
Practice Address - Street 1:302 EAST BUSINESS HIGHWAY 83
Practice Address - Street 2:STE 4 & 5
Practice Address - City:SAN JUAN
Practice Address - State:TX
Practice Address - Zip Code:78589
Practice Address - Country:US
Practice Address - Phone:956-575-7525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-27
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX923056669Medicaid