BERNICE GONZALEZ, MD, PA
Ambulatory Health at Broadway St, San Antonio, TX

License number
Texas J6466
Category
Ambulatory Health
Type
Clinic/Center
Owner
Name: DR. BERNICE GONZALEZ MD
Title: PRESIDENT
Phone: (210) 595-1019
Address
Address
2520 Broadway St SUITE 100, San Antonio, TX 78215
National Provider ID: 1184894701
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Organization information

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BERNICE GONZALEZ, M.D., PA

2520 Broadway St STE 100, San Antonio, TX 78215

Industry:
Medical Doctor's Office
Doing business as:
Bernice Gonzalez, M.D., PA<br>Vital Life Wellness Center
Registration:
Jun 19, 2007
State ID:
0800831879
Business type:
Professional Association
Director, Member, President:
Bernice Gonzalez (Director, Member, President)
Agent:
Vital Life Wellness Center,2520 Broadway STE 100, San Antonio, TX 78215 (Physical)
TIN:
32035005837

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