Provider Demographics
NPI:1891493136
Name:GONZALES, JOSE SEVERINO (DNP, CRNA)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:SEVERINO
Last Name:GONZALES
Suffix:
Gender:M
Credentials:DNP, CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3904 PELICAN AVE
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-5914
Mailing Address - Country:US
Mailing Address - Phone:956-533-2035
Mailing Address - Fax:
Practice Address - Street 1:3904 PELICAN AVE
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-5914
Practice Address - Country:US
Practice Address - Phone:956-533-2035
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-16
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1110499367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered