Provider Demographics
NPI:1164131850
Name:GONZALES, CLARISSA ANN
Entity Type:Individual
Prefix:MRS
First Name:CLARISSA
Middle Name:ANN
Last Name:GONZALES
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 1:7307 STILL BROOK ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78238-2739
Mailing Address - Country:US
Mailing Address - Phone:210-464-4321
Mailing Address - Fax:
Practice Address - Street 1:7307 STILL BROOK ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78238-2739
Practice Address - Country:US
Practice Address - Phone:210-464-4321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-21
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula