Provider Demographics
NPI:1275544223
Name:GONZALEZ, JOSUE RUBEN (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOSUE
Middle Name:RUBEN
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 TOPHILL RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-3447
Mailing Address - Country:US
Mailing Address - Phone:210-828-1200
Mailing Address - Fax:210-804-1089
Practice Address - Street 1:519 EVEREST ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-1717
Practice Address - Country:US
Practice Address - Phone:210-828-1200
Practice Address - Fax:210-804-1089
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2-1723103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
00KE20Medicare ID - Type Unspecified