Individual
ROSEANNA GONZALEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5545 S CASSIA WAY, TUCSON, AZ 85706-3409
(520) 286-1774
Mailing address
5545 S CASSIA WAY, TUCSON, AZ 85706-3409
(520) 286-1774
Taxonomy
Speciality
Code
Description
License number
State
385HR2055X
Child Mental Illness Respite Care
Primary
BH4935
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
BH4935
AZ DHS LICENSE
AZ
Enumeration date
08/12/2016
Last updated
08/12/2016
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