Individual
CASEY GONZALEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
5901 OURAY RD NW, ALBUQUERQUE, NM 87120-1381
(505) 836-0023
Mailing address
7 ROSA AVE SW, LOS LUNAS, NM 87031-8619
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
3228
NM
Other
Enumeration date
10/09/2015
Last updated
10/09/2015
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