Provider Demographics
NPI:1326597576
Name:GONZALEZ, SARA (MS, RD, LD)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6400 FANNIN ST
Mailing Address - Street 2:SUITE 2110
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-1521
Mailing Address - Country:US
Mailing Address - Phone:713-790-9220
Mailing Address - Fax:713-790-9309
Practice Address - Street 1:6400 FANNIN ST
Practice Address - Street 2:SUITE 2110
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-1521
Practice Address - Country:US
Practice Address - Phone:713-790-9220
Practice Address - Fax:713-790-9309
Is Sole Proprietor?:No
Enumeration Date:2016-09-29
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT07561133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered