Provider Demographics
NPI:1558195149
Name:GONZALES, CAROLYN MARIE (IBCLC)
Entity type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:MARIE
Last Name:GONZALES
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7632 AVENUE J
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77012-1030
Mailing Address - Country:US
Mailing Address - Phone:832-971-4412
Mailing Address - Fax:
Practice Address - Street 1:7632 AVENUE J
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77012-1030
Practice Address - Country:US
Practice Address - Phone:832-971-4412
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-27
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL-12233174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN