Provider Demographics
NPI:1194735290
Name:GONZALEZ-MARRERO, VIRNALISIS M (MD)
Entity type:Individual
Prefix:
First Name:VIRNALISIS
Middle Name:M
Last Name:GONZALEZ-MARRERO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 591455
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78259-0122
Mailing Address - Country:US
Mailing Address - Phone:210-268-4931
Mailing Address - Fax:210-695-7730
Practice Address - Street 1:10007 HUEBNER RD
Practice Address - Street 2:BLDG A SUITE 102
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-1675
Practice Address - Country:US
Practice Address - Phone:210-268-4941
Practice Address - Fax:210-695-7730
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM4105207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8G7579Medicare ID - Type Unspecified
TXG79072Medicare UPIN
TXTXB118652Medicare PIN