Individual
MIGUEL ROBERTO GONZALES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6036 N 19TH AVE STE 506, PHOENIX, AZ 85015-2143
(602) 246-5525
Mailing address
800 BRADBURY DR SE STE 116, ALBUQUERQUE, NM 87106-4310
(505) 272-1476
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD2019-0254
NM
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
04/21/2016
Last updated
03/10/2025
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