Individual
KEN GONZALES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CPSW
Contact information
Practice address
9201 MONTGOMERY BLVD NE STE V, ALBUQUERQUE, NM 87111-2470
(505) 507-7984
Mailing address
9201 MONTGOMERY BLVD NE STE V, ALBUQUERQUE, NM 87111-2470
(505) 507-7984
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
1607
NM
Other
Enumeration date
10/16/2023
Last updated
10/23/2023
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