Individual
MS. IVYROSE GONZALES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MOTR/L,ATC
Contact information
Practice address
2727 SAN PEDRO DR NE, STE 116, ALBUQUERQUE, NM 87110-3364
(505) 350-3069
(505) 508-2305
Mailing address
12105 DAN PATCH RD SE, ALBUQUERQUE, NM 87123-2196
(505) 350-3069
(505) 508-2305
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
—
—
225X00000X
Occupational Therapist
Primary
0805
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
93985312
—
NM
Enumeration date
08/20/2008
Last updated
03/14/2019
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