Provider Demographics
NPI:1740401363
Name:GONZALEZ, AMY M (TECHNICIAN)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:M
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:TECHNICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6825 ROUND TABLE
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78414
Mailing Address - Country:US
Mailing Address - Phone:985-201-0678
Mailing Address - Fax:361-939-6207
Practice Address - Street 1:U.S. COAST GUARD
Practice Address - Street 2:2100 2ND ST SW SUITE 5314
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20593
Practice Address - Country:US
Practice Address - Phone:985-201-0678
Practice Address - Fax:361-939-6207
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24720000X247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other