Provider Demographics
NPI:1225549777
Name:GONZALEZ, LUZ DEL CARMEN
Entity Type:Individual
Prefix:
First Name:LUZ
Middle Name:DEL CARMEN
Last Name:GONZALEZ
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 1:11640 NORMAN MONTION DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-0710
Mailing Address - Country:US
Mailing Address - Phone:915-849-1603
Mailing Address - Fax:
Practice Address - Street 1:11640 NORMAN MONTION DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-0710
Practice Address - Country:US
Practice Address - Phone:915-849-1603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-23
Last Update Date:2021-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXLHOC19-00007253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency