Provider Demographics
NPI:1285798785
Name:GONZALEZ-MORALES, EVELYN (MD)
Entity type:Individual
Prefix:DR
First Name:EVELYN
Middle Name:
Last Name:GONZALEZ-MORALES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11160 LA QUINTA PLACE
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-4122
Mailing Address - Country:US
Mailing Address - Phone:915-591-1494
Mailing Address - Fax:915-598-0610
Practice Address - Street 1:11160 LA QUINTA PLACE
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-4122
Practice Address - Country:US
Practice Address - Phone:915-591-1494
Practice Address - Fax:915-598-0610
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6968208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXF85040Medicare UPIN