Provider Demographics
NPI:1922384205
Name:GONZALEZ, ORLANDO (LMT)
Entity Type:Individual
Prefix:MR
First Name:ORLANDO
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5243
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78502-5243
Mailing Address - Country:US
Mailing Address - Phone:956-907-3787
Mailing Address - Fax:956-627-1445
Practice Address - Street 1:2600 N TAYLOR RD
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501-5407
Practice Address - Country:US
Practice Address - Phone:956-907-3787
Practice Address - Fax:956-627-1445
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-31
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT112008225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist