Provider Demographics
NPI:1992035968
Name:GSGNM, PLLC
Entity type:Organization
Organization Name:GSGNM, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MDMS NPI COMPLIANCE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:LIZETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:MORIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-598-2801
Mailing Address - Street 1:8403 STATE HIGHWAY 151
Mailing Address - Street 2:STE 104 #537
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78245-2055
Mailing Address - Country:US
Mailing Address - Phone:210-714-5507
Mailing Address - Fax:
Practice Address - Street 1:8403 STATE HIGHWAY 151
Practice Address - Street 2:STE 104 #538
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78245
Practice Address - Country:US
Practice Address - Phone:210-714-5507
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-13
Last Update Date:2017-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical NeurophysiologyGroup - Single Specialty