Provider Demographics
NPI:1225488372
Name:GONZALES, GUADALUPE CARLOS JR (LAC)
Entity Type:Individual
Prefix:
First Name:GUADALUPE
Middle Name:CARLOS
Last Name:GONZALES
Suffix:JR
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7959 BROADWAY ST
Mailing Address - Street 2:SUITE 602
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-2667
Mailing Address - Country:US
Mailing Address - Phone:210-320-7777
Mailing Address - Fax:
Practice Address - Street 1:7959 BROADWAY ST
Practice Address - Street 2:SUITE 602
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-2667
Practice Address - Country:US
Practice Address - Phone:210-320-7777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-20
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC00506171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist