Provider Demographics
NPI:1649777970
Name:PAVON GONZALEZ, GEORGES
Entity Type:Individual
Prefix:
First Name:GEORGES
Middle Name:
Last Name:PAVON GONZALEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16755 ELLA BLVD APT 18
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77090-4201
Mailing Address - Country:US
Mailing Address - Phone:832-533-6573
Mailing Address - Fax:
Practice Address - Street 1:16755 ELLA BLVD APT 18
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090-4201
Practice Address - Country:US
Practice Address - Phone:832-533-6572
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-12
Last Update Date:2018-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX918121163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse