Provider Demographics
NPI:1922585587
Name:GONZALES, ANTONIO BENJAMIN (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:ANTONIO
Middle Name:BENJAMIN
Last Name:GONZALES
Suffix:
Gender:M
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12200 WARE SEGUIN RD
Mailing Address - Street 2:
Mailing Address - City:SCHERTZ
Mailing Address - State:TX
Mailing Address - Zip Code:78154-6051
Mailing Address - Country:US
Mailing Address - Phone:210-718-1110
Mailing Address - Fax:
Practice Address - Street 1:5726 W HAUSMAN RD STE 109
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78249-1651
Practice Address - Country:US
Practice Address - Phone:210-349-7030
Practice Address - Fax:210-349-7030
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-25
Last Update Date:2018-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX712685163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health