Provider Demographics
NPI:1417987801
Name:GONZALEZ, MANUEL C (DNP, APRN, FNP-BC)
Entity Type:Individual
Prefix:DR
First Name:MANUEL
Middle Name:C
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:DNP, APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 PAPPAS ST
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-1705
Mailing Address - Country:US
Mailing Address - Phone:956-795-8100
Mailing Address - Fax:956-718-6294
Practice Address - Street 1:1515 PAPPAS ST
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-1705
Practice Address - Country:US
Practice Address - Phone:956-795-8100
Practice Address - Fax:956-718-6294
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP112042363LF0000X
TX547441363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX170859602Medicaid
TX170859602Medicaid
TX8G1758Medicare PIN
TX451961Medicare Oscar/Certification
TX547441OtherLICENSE NUMBER
TX451841Medicare Oscar/Certification
TX451960Medicare Oscar/Certification
TX451838Medicare Oscar/Certification
TX451962Medicare Oscar/Certification