Provider Demographics
NPI:1972575355
Name:GONZALES-DELIGANIS, MONICA L (OD)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:L
Last Name:GONZALES-DELIGANIS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:MONICA
Other - Middle Name:
Other - Last Name:GONZALES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7155 OLD KATY RD
Mailing Address - Street 2:N100
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-2134
Mailing Address - Country:US
Mailing Address - Phone:713-668-6828
Mailing Address - Fax:832-280-3636
Practice Address - Street 1:1250 CYPRESS STATION DR
Practice Address - Street 2:A
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090-3052
Practice Address - Country:US
Practice Address - Phone:281-444-1677
Practice Address - Fax:281-444-8631
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2013-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5401TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8L24515Medicare UPIN