Provider Demographics
NPI:1851314546
Name:GONZABA, ANNA PANTUSA (MD)
Entity Type:Individual
Prefix:DR
First Name:ANNA
Middle Name:PANTUSA
Last Name:GONZABA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 PLEASANTON RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78214-1306
Mailing Address - Country:US
Mailing Address - Phone:210-921-3800
Mailing Address - Fax:
Practice Address - Street 1:730 PLEASANTON RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78214-1306
Practice Address - Country:US
Practice Address - Phone:210-921-3800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH4598208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0059JGOtherBLUE CROSS NUMBER
TX0059JGOtherBLUE CROSS NUMBER
TX00146HMedicare ID - Type UnspecifiedMEDICARE NUMBER