Individual
GONZALO CORONA-GONZALEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
304 S LEA AVE, ROSWELL, NM 88203-4562
(575) 578-4815
(575) 578-4814
Mailing address
304 S LEA AVE, ROSWELL, NM 88203-4562
(575) 578-4815
(575) 578-4814
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD2007-0650
NM
208000000X
Pediatrics Physician
1391
VI
208000000X
Pediatrics Physician
MD2007-0650
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
11773537
—
NM
01
—
VI LICENSE
1391
VI
Enumeration date
06/11/2007
Last updated
11/20/2018
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