Provider Demographics
NPI:1891272852
Name:GONZALES, AMELIA MONIQUE (RN-BSN)
Entity Type:Individual
Prefix:MRS
First Name:AMELIA
Middle Name:MONIQUE
Last Name:GONZALES
Suffix:
Gender:F
Credentials:RN-BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2715 CORNERSTONE BLVD
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-8464
Mailing Address - Country:US
Mailing Address - Phone:956-627-2717
Mailing Address - Fax:956-627-2720
Practice Address - Street 1:2715 CORNERSTONE BLVD
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-8464
Practice Address - Country:US
Practice Address - Phone:956-627-2717
Practice Address - Fax:956-627-2720
Is Sole Proprietor?:No
Enumeration Date:2018-07-23
Last Update Date:2018-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX871879163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse