Provider Demographics
NPI:1487879730
Name:MANUEL GONZALEZ
Entity type:Organization
Organization Name:MANUEL GONZALEZ
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MANUEL
Authorized Official - Middle Name:HECTOR
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:915-872-9979
Mailing Address - Street 1:946 HORIZON BLVD
Mailing Address - Street 2:
Mailing Address - City:SOCORRO
Mailing Address - State:TX
Mailing Address - Zip Code:79927-4466
Mailing Address - Country:US
Mailing Address - Phone:915-872-9979
Mailing Address - Fax:915-790-2625
Practice Address - Street 1:946 HORIZON BLVD
Practice Address - Street 2:
Practice Address - City:SOCORRO
Practice Address - State:TX
Practice Address - Zip Code:79927-4466
Practice Address - Country:US
Practice Address - Phone:915-872-9979
Practice Address - Fax:915-790-2625
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX009543251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health