Provider Demographics
NPI:1326471939
Name:CSFA GONZALEZ
Entity Type:Organization
Organization Name:CSFA GONZALEZ
Other - Org Name:ROLANDO GONZALEZ
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CERTIFIED SURGICAL FIRST ASSIST
Authorized Official - Prefix:MR
Authorized Official - First Name:ROLANDO
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-744-9902
Mailing Address - Street 1:1131 91ST ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78214-3002
Mailing Address - Country:US
Mailing Address - Phone:210-744-9902
Mailing Address - Fax:
Practice Address - Street 1:1131 91ST ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78214-3002
Practice Address - Country:US
Practice Address - Phone:210-744-9902
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-19
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical AssistantGroup - Single Specialty