Provider Demographics
NPI:1942769351
Name:GONZALES, SABRINA ANN (BS, ATC, LAT)
Entity Type:Individual
Prefix:
First Name:SABRINA
Middle Name:ANN
Last Name:GONZALES
Suffix:
Gender:F
Credentials:BS, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6301 MEADOWVISTA DR APT 837
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78414-2637
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1 OWL SQ
Practice Address - Street 2:
Practice Address - City:ODEM
Practice Address - State:TX
Practice Address - Zip Code:78370-4388
Practice Address - Country:US
Practice Address - Phone:361-368-8121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-15
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2255A2300X, 261QS1000X
TXAT79412255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health