Provider Demographics
NPI:1225621451
Name:GONZALEZ, ELIDIA
Entity Type:Individual
Prefix:
First Name:ELIDIA
Middle Name:
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 1:2135 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EAGLE PASS
Mailing Address - State:TX
Mailing Address - Zip Code:78852-4895
Mailing Address - Country:US
Mailing Address - Phone:830-773-0420
Mailing Address - Fax:830-757-5752
Practice Address - Street 1:2135 E MAIN ST
Practice Address - Street 2:
Practice Address - City:EAGLE PASS
Practice Address - State:TX
Practice Address - Zip Code:78852-4895
Practice Address - Country:US
Practice Address - Phone:830-773-0420
Practice Address - Fax:830-757-5752
Is Sole Proprietor?:No
Enumeration Date:2021-02-18
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician