Provider Demographics
NPI:1992258115
Name:GONZALES, MARIA ISABEL (MSN, NP)
Entity type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:ISABEL
Last Name:GONZALES
Suffix:
Gender:F
Credentials:MSN, NP
Other - Prefix:MS
Other - First Name:MARIA
Other - Middle Name:ISABEL
Other - Last Name:DEGUZMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN, NP
Mailing Address - Street 1:6400 FANNIN ST STE 2070
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-1541
Mailing Address - Country:US
Mailing Address - Phone:713-704-6731
Mailing Address - Fax:713-704-6889
Practice Address - Street 1:6400 FANNIN ST STE 2800
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-1534
Practice Address - Country:US
Practice Address - Phone:713-704-7100
Practice Address - Fax:713-704-1262
Is Sole Proprietor?:No
Enumeration Date:2016-07-25
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP130271363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00106WOtherGRP MDCR PTAN NUMBER
TX153449704OtherMDCD TPI GRP #