Individual
MRS. MAGDELENIS GONGORA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
3551 ROGER BROOKE DR, FORT SAM HOUSTON, TX 78234-4504
(210) 916-7428
Mailing address
3551 ROGER BROOKE DR, FORT SAM HOUSTON, TX 78234-4504
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
R8196
TX
2080P0203X
Pediatric Critical Care Medicine Physician
Primary
R8196
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
395367102
—
TX
01
—
395367103
CSHCN
TX
Enumeration date
04/19/2012
Last updated
07/23/2025
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