Provider Demographics
NPI:1366086837
Name:GONZALEZ, MELISSA IVANA
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:IVANA
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1760 BARKER CYPRESS RD APT 1212
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77084-6183
Mailing Address - Country:US
Mailing Address - Phone:210-334-7239
Mailing Address - Fax:
Practice Address - Street 1:4840 W PANTHER CREEK DR STE 206
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77381-3542
Practice Address - Country:US
Practice Address - Phone:281-681-3020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-29
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX120268225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist