Provider Demographics
NPI:1104914266
Name:GONZALEZ, CARLOS JOSE (MD)
Entity type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:JOSE
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11301 FALLBROOK DR
Mailing Address - Street 2:304
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77065-4237
Mailing Address - Country:US
Mailing Address - Phone:281-955-7625
Mailing Address - Fax:281-955-2024
Practice Address - Street 1:11301 FALLBROOK DR
Practice Address - Street 2:304
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77065-4237
Practice Address - Country:US
Practice Address - Phone:281-955-7625
Practice Address - Fax:281-955-2024
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG2375174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG2375OtherSTATE LICENCE
TXG2375OtherSTATE LICENCE
TXB87831Medicare UPIN