Provider Demographics
NPI:1356470439
Name:FREDERICO GONZALES JR
Entity Type:Organization
Organization Name:FREDERICO GONZALES JR
Other - Org Name:AYUDA CASE MANAGEMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:FRED
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALES
Authorized Official - Suffix:
Authorized Official - Credentials:LBSW
Authorized Official - Phone:210-223-4066
Mailing Address - Street 1:1500 S ZARZAMORA ST STE 135
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78207-7224
Mailing Address - Country:US
Mailing Address - Phone:210-223-4066
Mailing Address - Fax:210-223-9377
Practice Address - Street 1:1500 S ZARZAMORA ST STE 135
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78207-7224
Practice Address - Country:US
Practice Address - Phone:210-223-4066
Practice Address - Fax:210-223-9377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX33688104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX143351803Medicaid