Provider Demographics
NPI:1942880851
Name:GONZALES, KRYSTAL ALEXANDRA I
Entity Type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:ALEXANDRA
Last Name:GONZALES
Suffix:I
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 N ROSILLO
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78207-3706
Mailing Address - Country:US
Mailing Address - Phone:210-227-0211
Mailing Address - Fax:
Practice Address - Street 1:108 N ROSILLO
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78207-3706
Practice Address - Country:US
Practice Address - Phone:210-227-0211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-13
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX298481183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician