Individual
AMANDA GONZALES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3695 HOT SPRINGS BLVD, LAS VEGAS, NM 87701-9549
(505) 454-2100
(505) 454-5172
Mailing address
3695 HOT SPRINGS BLVD, LAS VEGAS, NM 87701-9549
(505) 454-2100
(505) 454-5172
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
X10772
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
96296
—
NM
Enumeration date
12/19/2018
Last updated
12/19/2018
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