Provider Demographics
NPI:1033921093
Name:GONZALES, HOMER L
Entity type:Individual
Prefix:
First Name:HOMER
Middle Name:L
Last Name:GONZALES
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 1:5630 FAIRVIEW FOREST DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77088-1246
Mailing Address - Country:US
Mailing Address - Phone:704-421-2604
Mailing Address - Fax:
Practice Address - Street 1:5630 FAIRVIEW FOREST DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77088-1246
Practice Address - Country:US
Practice Address - Phone:704-421-2604
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-24
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter