Basic Information
| Provider Information | |||||||||
| NPI: | 1194460675 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GONZALEZ | ||||||||
| FirstName: | OSCAR | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11130 CHRISTUS HILLS | ||||||||
| Address2: | MEDICAL PLAZA 3, 3RD FLOOR | ||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782513585 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2107039001 | ||||||||
| FaxNumber: | 2107039155 | ||||||||
| Practice Location | |||||||||
| Address1: | 11130 CHRISTUS HILLS | ||||||||
| Address2: | MEDICAL PLAZA 3, 3RD FLOOR | ||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782513585 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2107039001 | ||||||||
| FaxNumber: | 2107039155 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/29/2022 | ||||||||
| LastUpdateDate: | 04/29/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/29/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | BP10080362 | TX | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.