Provider Demographics
NPI:1295157808
Name:GONZALEZ, JUAN
Entity type:Individual
Prefix:
First Name:JUAN
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 1:2200 PARK BEND DR
Mailing Address - Street 2:SUITE 300 BUILDING2
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-5387
Mailing Address - Country:US
Mailing Address - Phone:512-836-5665
Mailing Address - Fax:512-997-9092
Practice Address - Street 1:2200 PARK BEND DR
Practice Address - Street 2:SUITE 300 BUILDING2
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-5387
Practice Address - Country:US
Practice Address - Phone:512-836-5665
Practice Address - Fax:512-997-9092
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-16
Last Update Date:2014-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other