Individual
MARIO GONZALEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1061 HARMON AVE, FORT STEWART, GA 31314-5641
(209) 581-6319
Mailing address
1061 HARMON AVE, FORT STEWART, GA 31314-5641
Taxonomy
Speciality
Code
Description
License number
State
146N00000X
Basic Emergency Medical Technician
Primary
E3104001
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
E3104001
EMT
TX
Enumeration date
09/08/2014
Last updated
09/08/2014
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