Provider Demographics
NPI:1154415453
Name:GONZALEZ, ROSABEL ZAMORA
Entity type:Individual
Prefix:MRS
First Name:ROSABEL
Middle Name:ZAMORA
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:ROSABEL
Other - Middle Name:
Other - Last Name:ZAMORA GONZALEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10041 HELMS TRAIL
Mailing Address - Street 2:
Mailing Address - City:FORNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75126-8076
Mailing Address - Country:US
Mailing Address - Phone:972-552-3233
Mailing Address - Fax:972-552-3335
Practice Address - Street 1:10041 HELMS TRAIL
Practice Address - Street 2:
Practice Address - City:FORNEY
Practice Address - State:TX
Practice Address - Zip Code:75126-8076
Practice Address - Country:US
Practice Address - Phone:972-552-3233
Practice Address - Fax:972-552-3335
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2008-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32020002187225000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX6094710001Medicare NSC