Basic Information
| Provider Information | |||||||||
| NPI: | 1205121597 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GONZALES | ||||||||
| FirstName: | LIZETTE | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 809 S LAMAR BLVD APT 417 | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787041573 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5127408254 | ||||||||
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| Practice Location | |||||||||
| Address1: | 9900 S IH 35 | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787483885 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5122915577 | ||||||||
| FaxNumber: | 5122915576 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2011 | ||||||||
| LastUpdateDate: | 12/27/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | P7448 | TX | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.