Individual
MARIA GONZALES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
31 ROAD 6195, KIRTLAND, NM 87417-9332
(505) 258-4560
Mailing address
31 ROAD 6195, KIRTLAND, NM 87417-9332
(505) 258-4560
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
5405
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2129992021
—
NM
Enumeration date
10/29/2013
Last updated
10/29/2013
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