Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | Q2136 | TX |
NPI | 1003172198 |
---|---|
Provider Name | Vanessa Casanova Gonzalez |
First Address | Corpus Christi, TX 78466-1160 |
Second Address | Corpus Christi, TX 78411-1721 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2012 |
Last Update Date | 25/07/2019 |