Provider Demographics
NPI:1356635882
Name:GONZALES, FELICITAS S (MD)
Entity type:Individual
Prefix:DR
First Name:FELICITAS
Middle Name:S
Last Name:GONZALES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8711 VILLAGE DR STE 114
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-5419
Mailing Address - Country:US
Mailing Address - Phone:210-220-6744
Mailing Address - Fax:210-200-6799
Practice Address - Street 1:16088 SAN PEDRO AVE STE 115
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-2251
Practice Address - Country:US
Practice Address - Phone:210-220-6744
Practice Address - Fax:210-200-6799
Is Sole Proprietor?:No
Enumeration Date:2011-06-01
Last Update Date:2018-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ0446207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine