Provider Demographics
NPI:1841420858
Name:RUNDLE-GONZALEZ, VALERIE (MD)
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:
Last Name:RUNDLE-GONZALEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:VALERIE
Other - Middle Name:
Other - Last Name:RUNDLE GONZALEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4201 BEE CAVES RD STE C213
Mailing Address - Street 2:
Mailing Address - City:WEST LAKE HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:78746-6458
Mailing Address - Country:US
Mailing Address - Phone:512-960-4717
Mailing Address - Fax:855-868-9882
Practice Address - Street 1:4201 BEE CAVES RD STE C213
Practice Address - Street 2:
Practice Address - City:WEST LAKE HILLS
Practice Address - State:TX
Practice Address - Zip Code:78746-6458
Practice Address - Country:US
Practice Address - Phone:512-960-4717
Practice Address - Fax:855-868-9882
Is Sole Proprietor?:No
Enumeration Date:2009-07-24
Last Update Date:2015-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 1167842084N0400X
TXQ45102084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL009790800Medicaid
FLHO901ZMedicare PIN