Provider Demographics
NPI:1780218834
Name:GONZALEZ LEAL, REBECA J
Entity Type:Individual
Prefix:MRS
First Name:REBECA
Middle Name:J
Last Name:GONZALEZ LEAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:REBECA
Other - Middle Name:JESSUANY
Other - Last Name:GONZALEZ SALINAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1201 W UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-2909
Mailing Address - Country:US
Mailing Address - Phone:956-665-7049
Mailing Address - Fax:
Practice Address - Street 1:1201 W UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-2909
Practice Address - Country:US
Practice Address - Phone:956-665-7049
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-27
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXRBT-19-10176106S00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician