Mark Joseph Gonzales
Individual provider Active NPI Surgical Assistant · Lytle, TX
NPI 1699178756 · NPPES record last updated Jul 22, 2022
Key facts
- NPI
- 1699178756
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Surgical Assistant 246ZC0007X
- License
- SA00742 (TX)
- Practice address
- 16874 FM 463
Lytle, TX 78052-4515 - Phone
- (210) 239-6873
- NPI assigned
- Oct 3, 2014
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SA00742 | TX | MD | Surgical Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| MG Medical Billing LLC | Surgical Assistant | Current |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgical Assistant | 246ZC0007X | SA00742 | TX | Yes |
Addresses
Primary practice location
16874 FM 463
Lytle, TX 78052-4515
Mailing address
16874 FM 463
Lytle, TX 78052-4515
Phone (210) 239-6873
Other providers in Lytle, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 22, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.