Provider Demographics
NPI:1245782705
Name:SILVA-GONZALEZ, JAZIEL ISAI (AUD)
Entity Type:Individual
Prefix:DR
First Name:JAZIEL
Middle Name:ISAI
Last Name:SILVA-GONZALEZ
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10414 MEDICAL LOOP UNIT E2
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78045-6612
Mailing Address - Country:US
Mailing Address - Phone:956-462-5848
Mailing Address - Fax:956-462-5866
Practice Address - Street 1:10414 MEDICAL LOOP UNIT F
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78045-6612
Practice Address - Country:US
Practice Address - Phone:956-462-5848
Practice Address - Fax:956-462-5866
Is Sole Proprietor?:No
Enumeration Date:2016-11-01
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80917231H00000X, 237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX28575991OtherDRIVER'S LICENSE