Provider Demographics
NPI:1619220928
Name:CARLOS GONZALEZ
Entity Type:Organization
Organization Name:CARLOS GONZALEZ
Other - Org Name:SOUTHWEST ORTHOPAEDIC CLINIC, P.A.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:915-592-3323
Mailing Address - Street 1:10410 VISTA DEL SOL DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79925-7919
Mailing Address - Country:US
Mailing Address - Phone:915-592-3323
Mailing Address - Fax:915-593-8571
Practice Address - Street 1:10410 VISTA DEL SOL DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-7919
Practice Address - Country:US
Practice Address - Phone:915-592-3323
Practice Address - Fax:915-593-8571
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-24
Last Update Date:2013-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP0979207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB165926Medicare PIN