Individual
MIGUEL ANGEL GONZALEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ED.S
Contact information
Practice address
1453 N. MAIN ST., SUITE F, SAN LUIS, AZ 85349
(928) 627-6567
Mailing address
1453 N. MAIN ST, SUITE F, SAN LUIS, AZ 85349
(928) 627-6567
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
—
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
838188
AHCCCS
AZ
Enumeration date
03/23/2007
Last updated
07/26/2007
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