Provider Demographics
NPI:1437192655
Name:GONZALEZ, ADELNERY (MD)
Entity type:Individual
Prefix:
First Name:ADELNERY
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ADELNERY
Other - Middle Name:
Other - Last Name:GONZALEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:15714 HUEBNER RD
Mailing Address - Street 2:BLDG #3
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78248
Mailing Address - Country:US
Mailing Address - Phone:210-447-3000
Mailing Address - Fax:210-447-3001
Practice Address - Street 1:15714 HUEBNER RD
Practice Address - Street 2:BLDG #3
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78248
Practice Address - Country:US
Practice Address - Phone:210-447-3000
Practice Address - Fax:210-447-3001
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK1452208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX120641901Medicaid
TX120641904Medicaid
TXH00122Medicare UPIN
TX120641901Medicaid