Provider Demographics
NPI:1306667217
Name:VIRUET GONZALEZ, HAZEL CAMILLE (DC)
Entity type:Individual
Prefix:
First Name:HAZEL
Middle Name:CAMILLE
Last Name:VIRUET GONZALEZ
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3708 MADISON DR
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76543
Mailing Address - Country:US
Mailing Address - Phone:787-948-2449
Mailing Address - Fax:
Practice Address - Street 1:1015 W 39TH 1/2 ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78756-4005
Practice Address - Country:US
Practice Address - Phone:512-371-7478
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-23
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16209111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor