Provider Demographics
NPI:1134390420
Name:MANUEL GONZALEZ
Entity type:Organization
Organization Name:MANUEL GONZALEZ
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MANUEL
Authorized Official - Middle Name:HECTOR
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:915-851-4663
Mailing Address - Street 1:PO BOX 1136
Mailing Address - Street 2:
Mailing Address - City:CLINT
Mailing Address - State:TX
Mailing Address - Zip Code:79836-1136
Mailing Address - Country:US
Mailing Address - Phone:915-851-4663
Mailing Address - Fax:951-851-0899
Practice Address - Street 1:440 FM 1110
Practice Address - Street 2:
Practice Address - City:SAN ELIZARIO
Practice Address - State:TX
Practice Address - Zip Code:79849
Practice Address - Country:US
Practice Address - Phone:915-851-4663
Practice Address - Fax:951-851-0899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-14
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX010935251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health