Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | 101 | TX |
N | 222Z00000X | Podiatrist | 101 | TX |
Y | 224P00000X | Prosthetist | 101 | TX |
NPI | 1144586389 |
---|---|
Provider Name | Mr. Lorenzo L. Gonzalez |
First Address | San Antonio, TX 78249-3399 |
Second Address | San Antonio, TX 78249-3399 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/04/2012 |
Last Update Date | 02/04/2012 |