Provider Demographics
NPI:1952636250
Name:GONZALEZ, VICTOR L
Entity Type:Individual
Prefix:MR
First Name:VICTOR
Middle Name:L
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4305 N 10TH ST # ST2
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-3051
Mailing Address - Country:US
Mailing Address - Phone:956-867-4284
Mailing Address - Fax:
Practice Address - Street 1:4305 N 10TH ST STE J2
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-2976
Practice Address - Country:US
Practice Address - Phone:956-867-4284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-05
Last Update Date:2009-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1000316146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic