Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LC1500X | Nurse Practitioner - Community Health | AP125956 | TX |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | AP125956 | TX |
N | 363LP2300X | Nurse Practitioner - Primary Care | AP125956 | TX |
NPI | 1285033142 |
---|---|
Provider Name | Mr. Maru Luis Gonzales Ladilad |
First Address | Brownsville, TX 78521-2482 |
Second Address | Brownsville, TX 78521-2482 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2014 |
Last Update Date | 17/08/2014 |