Individual
MR. EDGARDO MAURICIO GONZALEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CSA, LSA
Contact information
Practice address
17201 INTERSTATE 45 S, SHENANDOAH, TX 77385-3311
(305) 610-0506
Mailing address
34 CHESWOOD MANOR DR, THE WOODLANDS, TX 77382-5380
(305) 610-0506
Taxonomy
Speciality
Code
Description
License number
State
246ZC0007X
Surgical Assistant
16-165
WI
363AS0400X
Surgical Physician Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
16-165
AMERICAN BOARD OF SURGICAL ASSISTANTS
—
01
—
SA00743
MEDICAL BOARD OF TEXAS
TX
Enumeration date
04/14/2016
Last updated
12/05/2023
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