Provider Demographics
NPI:1801089941
Name:GONZALEZ, AIXA (MD)
Entity type:Individual
Prefix:
First Name:AIXA
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:AIXA
Other - Middle Name:
Other - Last Name:PEREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:104 MARK DR
Mailing Address - Street 2:
Mailing Address - City:EDENTON
Mailing Address - State:NC
Mailing Address - Zip Code:27932-1756
Mailing Address - Country:US
Mailing Address - Phone:252-482-5171
Mailing Address - Fax:252-809-5172
Practice Address - Street 1:9939 HIGHWAY 151
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78251-1900
Practice Address - Country:US
Practice Address - Phone:210-706-7800
Practice Address - Fax:210-949-9581
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-22
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE25202207R00000X
NC2016-00990207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine