Provider Demographics
NPI:1548734395
Name:GONZALEZ, VICTARIA LATARA (FNP)
Entity Type:Individual
Prefix:
First Name:VICTARIA
Middle Name:LATARA
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3464 MIKE GODWIN DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-2765
Mailing Address - Country:US
Mailing Address - Phone:915-490-8381
Mailing Address - Fax:
Practice Address - Street 1:3270 JOE BATTLE BLVD STE 175
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79938-2671
Practice Address - Country:US
Practice Address - Phone:915-504-6939
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-15
Last Update Date:2019-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX139935363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily