Provider Demographics
NPI:1922470335
Name:GONZALEZ, CLEMENTE (FNP- BC)
Entity Type:Individual
Prefix:
First Name:CLEMENTE
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:FNP- BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2121 E GRIFFIN PKWY STE 11
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-3072
Mailing Address - Country:US
Mailing Address - Phone:956-580-3350
Mailing Address - Fax:956-580-7925
Practice Address - Street 1:2121 E GRIFFIN PKWY STE 11
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-3072
Practice Address - Country:US
Practice Address - Phone:956-580-3350
Practice Address - Fax:956-580-7925
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-24
Last Update Date:2016-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2015009023363LF0000X
TXAP129185363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily