Provider Demographics
NPI:1265942593
Name:GONZALEZ, MARIA LUISA
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:LUISA
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5916 WIND DRIFT TRL
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76017-4220
Mailing Address - Country:US
Mailing Address - Phone:817-307-0677
Mailing Address - Fax:
Practice Address - Street 1:5916 WIND DRIFT TRAIL
Practice Address - Street 2:
Practice Address - City:ARLLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76017
Practice Address - Country:US
Practice Address - Phone:817-307-0677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Single Specialty