Provider Demographics
NPI:1609201425
Name:MARISSA R GONZALEZ MD PLLC
Entity Type:Organization
Organization Name:MARISSA R GONZALEZ MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARISSA
Authorized Official - Middle Name:R
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-726-6937
Mailing Address - Street 1:220 W HILLSIDE RD
Mailing Address - Street 2:STE 4A
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-6903
Mailing Address - Country:US
Mailing Address - Phone:956-726-6937
Mailing Address - Fax:888-972-3859
Practice Address - Street 1:220 W HILLSIDE RD
Practice Address - Street 2:STE 4A
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-6903
Practice Address - Country:US
Practice Address - Phone:956-726-6937
Practice Address - Fax:866-916-2013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-11
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP4170207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty