Provider Information for 1538211867
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Mr. PEDRO RICARDO GONZALEZ LPC
Sex: Male
NPI: 1538211867
Last Updated: 2007-08-01
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1538211867 | ||||||||||||
| Enumeration Date | 2007-01-17 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | YES | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 7600 W MILITARY DR TRLR 112 SAN ANTONIO, TX 78227-1964 United States Phone: 210-274-4507 | Fax:210-670-8236 | ||||||||||||
| Primary Practice Address | 117 SOUTHBRIDGE ST SAN ANTONIO, TX 78216-6229 United States Phone: 210-274-4507 | Fax:210-670-8236 | ||||||||||||
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