Provider Demographics
NPI:1679532667
Name:GONZALEZ, ROBERTO (MS, RD, LD, CDE)
Entity type:Individual
Prefix:
First Name:ROBERTO
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:MS, RD, LD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1710 AUDREY DR
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75040-5530
Mailing Address - Country:US
Mailing Address - Phone:713-306-8025
Mailing Address - Fax:
Practice Address - Street 1:8198 WALNUT HILL LN
Practice Address - Street 2:JACKSON LL, DIABETES EDUCATION CENTER
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-4316
Practice Address - Country:US
Practice Address - Phone:214-345-4330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT07370133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
21110156OtherNATIONAL CERTIFICATION BOARD FOR DIABETES EDUCATORS
TXDT07370OtherTX LICENSED DIETITIAN