Individual
MR. ANTONIO GONZALES JACQUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
COTAL
Contact information
Practice address
900 CENTRAL, BAYARD, NM 88023
(505) 537-4000
(505) 537-3921
Mailing address
1414 LITTLE WALNUT RD, APT 8G, SILVER CITY, NM 88061
(505) 534-0781
(505) 537-3921
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
2225
NM
Other
Enumeration date
03/05/2007
Last updated
07/08/2007
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