Provider Demographics
NPI:1083984793
Name:GONZALES, VINCENT (LSA)
Entity Type:Individual
Prefix:MR
First Name:VINCENT
Middle Name:
Last Name:GONZALES
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 1:1 SUGAR CREEK CENTER BLVD STE 618
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-3540
Mailing Address - Country:US
Mailing Address - Phone:832-655-4141
Mailing Address - Fax:713-457-5188
Practice Address - Street 1:1 SUGAR CREEK CENTER BLVD STE 618
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478
Practice Address - Country:US
Practice Address - Phone:832-655-4141
Practice Address - Fax:713-457-5188
Is Sole Proprietor?:No
Enumeration Date:2012-01-11
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXSA00666246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8JY416OtherBCBS - UNIVERSAL SURGICAL ASSISTANTS
TX8PX954OtherBCBS - US MSO
TX8BK141OtherBCBS - UNIVERSAL SURGICAL PARTNERS
TX8KD550OtherBCBS - XCITE SURGICAL
TX8LH924OtherBCBS - BLUE STAR SURGICAL ASSISTANTS LLC
TXSA00666OtherTEXAS MEDICAL BOARD