Provider Demographics
NPI:1245064922
Name:GONZALEZ, ALEX
Entity type:Individual
Prefix:MR
First Name:ALEX
Middle Name:
Last Name:GONZALEZ
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 1:1720 VINTAGE DR APT 14
Mailing Address - Street 2:
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70065-5666
Mailing Address - Country:US
Mailing Address - Phone:504-273-3410
Mailing Address - Fax:
Practice Address - Street 1:1720 VINTAGE DR APT 14
Practice Address - Street 2:
Practice Address - City:KENNER
Practice Address - State:LA
Practice Address - Zip Code:70065-5666
Practice Address - Country:US
Practice Address - Phone:504-273-3410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-27
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA972GLS343800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343800000XTransportation ServicesSecured Medical Transport (VAN)