Provider Demographics
NPI:1487217618
Name:GONZALEZ, MARTHA ALEJANDRA (DO)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:ALEJANDRA
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5601 EXECUTIVE DR STE 200
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75038-2508
Mailing Address - Country:US
Mailing Address - Phone:352-565-7290
Mailing Address - Fax:352-565-7290
Practice Address - Street 1:5601 EXECUTIVE DR STE 200
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75038-2508
Practice Address - Country:US
Practice Address - Phone:352-565-7290
Practice Address - Fax:352-565-7290
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-14
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXT3288207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine