Individual
MR. MARTIN GONZALES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3924 W MARICOPA ST, PHOENIX, AZ 85009-5410
(602) 353-9352
Mailing address
3924 W MARICOPA ST, PHOENIX, AZ 85009-5410
(602) 353-9352
Taxonomy
Speciality
Code
Description
License number
State
385HR2055X
Child Mental Illness Respite Care
Primary
8896
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
910035
AHCCCS ID NUMBER
AZ
Enumeration date
11/20/2006
Last updated
07/08/2007
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