Edgardo Mauricio Gonzalez, CSA, LSA

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

Practice address

17201 Interstate 45 S
Shenandoah, TX 77385-3311

Phone

(305) 610-0506

NPI assigned

Apr 14, 2016

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1460592000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701734400000",
    "number": "1982058053",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "34 CHESWOOD MANOR DR",
            "city": "THE WOODLANDS",
            "state": "TX",
            "postal_code": "773825380",
            "telephone_number": "305-610-0506"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17201 INTERSTATE 45 S",
            "city": "SHENANDOAH",
            "state": "TX",
            "postal_code": "773853311",
            "telephone_number": "305-610-0506"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GONZALEZ",
        "first_name": "EDGARDO",
        "middle_name": "MAURICIO",
        "name_prefix": "Mr.",
        "credential": "CSA, LSA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-04-14",
        "last_updated": "2023-12-05",
        "certification_date": "2023-12-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "246ZC0007X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Other, Surgical Assistant",
            "state": "WI",
            "license": "16-165",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL BOARD OF TEXAS",
            "identifier": "SA00743",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERICAN BOARD OF SURGICAL ASSISTANTS",
            "identifier": "16-165",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Clare Glassock
• Anuj Goel, MD
• Andrew Shagor Gomes, DDS
• Sarah Laurelle Gomez
• Anna M Gonzales, M.D.
• Manuel Gonzalez
• Gordley Plastic Surgery PA
• Kyle Patrick Gordley, M.D.
• Natalie Danielle Gordon, M.D.
• Steven Lars Gordon, M.D.

• Surgical Physician Assistant in Shenandoah, TX
• Providers in Shenandoah, TX by specialty
• Surgical Physician Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2023; 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.