Provider Demographics
NPI:1871382234
Name:GONZALES, VANESSA (RN)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:GONZALES
Suffix:
Gender:
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2773 HOUGHTON AVE
Mailing Address - Street 2:
Mailing Address - City:INGLESIDE
Mailing Address - State:TX
Mailing Address - Zip Code:78362-5733
Mailing Address - Country:US
Mailing Address - Phone:361-215-6554
Mailing Address - Fax:
Practice Address - Street 1:2582 MAIN ST STE B
Practice Address - Street 2:
Practice Address - City:INGLESIDE
Practice Address - State:TX
Practice Address - Zip Code:78362-6054
Practice Address - Country:US
Practice Address - Phone:361-229-7217
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-02
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX56787075246Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246Q00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyGroup - Single Specialty