Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 1254999 | TX |
N | 2081S0010X | Sports Medicine | 1254999 | TX |
N | 213ES0000X | Sports Medicine | 1254999 | TX |
NPI | 1164978185 |
---|---|
Provider Name | Ms. Sara M Gonzalez |
First Address | El Paso, TX 79936-7905 |
Second Address | El Paso, TX 79925-7919 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2016 |
Last Update Date | 07/10/2020 |