Individual
MRS. TAMMY GONZALES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CNMT
Contact information
Practice address
613 W GRANT AVE, PUEBLO, CO 81004-1442
(719) 821-1180
Mailing address
613 W GRANT AVE, PUEBLO, CO 81004-1442
(719) 821-1180
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
MT.0004628
CO
Other
Enumeration date
03/11/2013
Last updated
03/11/2013
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