Group Member Provider/Supplier Name: MARY GONZALEZ Primary Practice Location: 500 E CAESAR AVE, STATCARE MINOR EMERGENCY CLINIC, KINGSVILLE, TX 78363-6322 Group Member National Provider Identifier (NPI): 1952713083 Group Member Provider Transaction Access Number (PTAN): 1D8276 Group Member Specialty: NURSE PRACTITIONER You are a: PARTICIPATING PROVIDER Effective Date: MAY 01, 2020 Group Legal Business Name/PTAN: RABAGOS HEALTH CARE PLLC 369376 Group National Provider Identifier (NPI): 1689924904