Provider Demographics
NPI:1609122274
Name:GONZALEZ, LESLIE JADE (CST, CSA, LSA)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:JADE
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:CST, CSA, LSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3346 CLIPPER WINDS WAY
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77084-7625
Mailing Address - Country:US
Mailing Address - Phone:832-499-6964
Mailing Address - Fax:
Practice Address - Street 1:3346 CLIPPER WINDS WAY
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77084-7625
Practice Address - Country:US
Practice Address - Phone:832-499-6964
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-01
Last Update Date:2015-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXSA00535246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant