Individual
SELENE VERONICA GONZALEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5242 W JESSICA LN, LAVEEN, AZ 85339-2447
(602) 753-8389
Mailing address
5242 W JESSICA LN, LAVEEN, AZ 85339-2447
(602) 753-8389
Taxonomy
Speciality
Code
Description
License number
State
372500000X
Chore Provider
—
—
372600000X
Adult Companion
—
—
373H00000X
Day Training/Habilitation Specialist
—
—
3747A0650X
Attendant Care Provider
Primary
—
—
3747P1801X
Personal Care Attendant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
871070
—
AZ
Enumeration date
06/25/2013
Last updated
05/29/2014
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