Provider Demographics
NPI:1114937216
Name:GONZALEZ-SOZER, MARIAELENA (MD)
Entity Type:Individual
Prefix:
First Name:MARIAELENA
Middle Name:
Last Name:GONZALEZ-SOZER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARIAELENA
Other - Middle Name:
Other - Last Name:GONZALEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5959 GATEWAY BLVD W
Mailing Address - Street 2:STE. 120
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79925-3331
Mailing Address - Country:US
Mailing Address - Phone:915-779-1716
Mailing Address - Fax:915-771-6558
Practice Address - Street 1:125 W HAGUE RD
Practice Address - Street 2:STE.110
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-5814
Practice Address - Country:US
Practice Address - Phone:915-351-7644
Practice Address - Fax:915-351-2928
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK4904207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0014HLOtherBCBS
TX0014HLOtherBCBS
TX00968QMedicare PIN