Provider Demographics
NPI:1356698666
Name:GONZALES, ILEANA (RN)
Entity type:Individual
Prefix:
First Name:ILEANA
Middle Name:
Last Name:GONZALES
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6400 FANNIN STREET,
Mailing Address - Street 2:SUITE 2130
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030
Mailing Address - Country:US
Mailing Address - Phone:713-383-6400
Mailing Address - Fax:713-383-6401
Practice Address - Street 1:6400 FANNIN STREET,
Practice Address - Street 2:SUITE 2130
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030
Practice Address - Country:US
Practice Address - Phone:713-383-6400
Practice Address - Fax:713-383-6401
Is Sole Proprietor?:No
Enumeration Date:2012-08-07
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX769737208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery