Provider Demographics
NPI:1982019600
Name:GONZALEZ, RUBY
Entity Type:Individual
Prefix:
First Name:RUBY
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:RUBY
Other - Middle Name:SMITH
Other - Last Name:GONZALEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:SW
Mailing Address - Street 1:2445 MONARCH #404
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78045
Mailing Address - Country:US
Mailing Address - Phone:956-251-1586
Mailing Address - Fax:
Practice Address - Street 1:2445 MONARCH DR UNIT 404
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78045-6429
Practice Address - Country:US
Practice Address - Phone:956-337-3699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-23
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14038104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker