Individual
AMY BREEDLOVE GONZALES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1600 N INTERSTATE 35, SAN MARCOS, TX 78666-6984
(512) 618-2826
Mailing address
124 CREST CIRCLE DR, SAN MARCOS, TX 78666-9329
(512) 618-2826
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA00658
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
307772901
—
TX
05
—
307772902
—
TX
Enumeration date
08/23/2006
Last updated
03/07/2022
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