Provider Demographics
NPI:1316571466
Name:GONZALEZ, SANDRA ROSE (RBT)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:ROSE
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3145 CENTER POINT DR
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-8433
Mailing Address - Country:US
Mailing Address - Phone:956-322-5647
Mailing Address - Fax:
Practice Address - Street 1:3145 CENTER POINT DR
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-8433
Practice Address - Country:US
Practice Address - Phone:956-322-5647
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-27
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXRBT-19-104215106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician