Provider Demographics
NPI:1962683185
Name:GONZALEZ, LORELEI A (MD)
Entity Type:Individual
Prefix:DR
First Name:LORELEI
Middle Name:A
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 N SANTA ROSA ST
Mailing Address - Street 2:SUITE D4023
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78207-3108
Mailing Address - Country:US
Mailing Address - Phone:469-282-2711
Mailing Address - Fax:469-282-2609
Practice Address - Street 1:11345 ALAMO RANCH PKWY
Practice Address - Street 2:STE 203
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78253-6440
Practice Address - Country:US
Practice Address - Phone:210-767-4000
Practice Address - Fax:210-688-9418
Is Sole Proprietor?:No
Enumeration Date:2007-11-15
Last Update Date:2016-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM9318208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX195527001Medicaid
TX195527003Medicaid
TX195527005Medicaid