Provider Demographics
NPI:1316983547
Name:GONZALEZ, CESAR (MPT)
Entity type:Individual
Prefix:
First Name:CESAR
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11937 DAVID FORTI DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-0659
Mailing Address - Country:US
Mailing Address - Phone:915-849-8061
Mailing Address - Fax:
Practice Address - Street 1:1774 N ZARAGOZA RD
Practice Address - Street 2:SUITE A
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-7909
Practice Address - Country:US
Practice Address - Phone:915-855-6466
Practice Address - Fax:915-855-6181
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1156759225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8D7738Medicare PIN