Provider Demographics
NPI:1114080140
Name:GONZALEZ, RAQUEL ESTRADA (PHD)
Entity Type:Individual
Prefix:
First Name:RAQUEL
Middle Name:ESTRADA
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:RAQUEL
Other - Middle Name:
Other - Last Name:ESTRADA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:7272 WURZBACH RD
Mailing Address - Street 2:SUITE 601
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-4801
Mailing Address - Country:US
Mailing Address - Phone:210-615-8880
Mailing Address - Fax:210-615-2279
Practice Address - Street 1:7272 WURZBACH RD
Practice Address - Street 2:SUITE 601
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-4801
Practice Address - Country:US
Practice Address - Phone:210-615-8880
Practice Address - Fax:210-615-2279
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2019-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX56995101YP2500X
TX32207103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX32207OtherLICENSE