Provider Demographics
NPI:1699758615
Name:GONZALEZ, ANGELICA M (O D)
Entity type:Individual
Prefix:DR
First Name:ANGELICA
Middle Name:M
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:O D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 W KLEBERG AVE
Mailing Address - Street 2:
Mailing Address - City:KINGSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78363-4427
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:219 W KLEBERG AVE
Practice Address - Street 2:
Practice Address - City:KINGSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78363-4427
Practice Address - Country:US
Practice Address - Phone:361-592-6443
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2016-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6530T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX19544OtherLIFE RE
TX51025OtherDAVIS VISION
TX174382501Medicaid
TX81401QOtherBCBS
TX174731301Medicaid
TX81401QOtherBCBS
TX174382501Medicaid
TXV04233Medicare UPIN