Individual
AUTUMN MARIE GONZALES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3917 WEST RD STE A, LOS ALAMOS, NM 87544-2292
(505) 661-8900
Mailing address
3917 WEST RD STE A, LOS ALAMOS, NM 87544-2292
(505) 661-8900
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA2023-0240
NM
390200000X
Student in an Organized Health Care Education/Training Program
—
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Other
Enumeration date
10/09/2021
Last updated
08/09/2023
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