NPIMap

Organization Active NPI

Bernice Gonzalez, MD, PA

Doing business as Vital Life Wellness Center

  • Clinic/Center
  • San Antonio, TX
National Provider Identifier
1184894701
Registry record updated May 8, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
License
J6466 Issued in TX
Legal business name
BERNICE GONZALEZ, MD, PA
Doing business as
Vital Life Wellness Center
Practice address
2520 Broadway St
Suite 100
San Antonio, TX 78215-1004
Phone
(210) 595-1019
Fax
(210) 251-3194
NPI assigned
Mar 11, 2008
Last updated
May 8, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 8, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Bernice Gonzalez, MDNPI 1184622904
Title
President
Phone
(210) 595-1019

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X J6466 TX Primary

Addresses

Primary practice location

2520 Broadway St
Suite 100
San Antonio, TX 78215-1004

Mailing address

2520 Broadway Street
Suite 100
San Antonio, TX 78215
Phone (210) 595-1019

Other names 1

  • Vital Life Wellness Center Doing business as

National Provider Directory

National Provider Directory

Locations

2501 W William Cannon Dr
Ste 202
Austin, TX 78745
Phone (210) 595-1019

2828 N Loop 1604 E Ste 104
San Antonio, TX 78232

418 N Loop 1604 W
San Antonio, TX 78232
Phone (210) 595-1019

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/12437/brand/1/csg/1/fhir/r4

Practitioners & affiliated clinicians

Practitioners 19

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 19

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1205193600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1367971200000",
    "number": "1184894701",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2520 BROADWAY STREET",
            "address_2": "SUITE 100",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "78215",
            "telephone_number": "210-595-1019",
            "fax_number": "210-251-3194"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2520 BROADWAY ST",
            "address_2": "SUITE 100",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782151004",
            "telephone_number": "210-595-1019",
            "fax_number": "210-251-3194"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BERNICE GONZALEZ, MD, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-11",
        "last_updated": "2013-05-08",
        "status": "A",
        "authorized_official_last_name": "GONZALEZ",
        "authorized_official_first_name": "BERNICE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "210-595-1019",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "TX",
            "license": "J6466",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Vital Life Wellness Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in San Antonio, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.