Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | 99052 | TX |
NPI | 1043496615 |
---|---|
Provider Name | Salli Marie Gonzalez |
First Address | Seguin, TX 78155-3114 |
Second Address | Seguin, TX 78155-3114 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/01/2008 |
Last Update Date | 14/01/2008 |