Individual
ALISA GONZALES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CCSS
Contact information
Practice address
614 BECKER AVE, BELEN, NM 87002-3634
(575) 835-4357
(505) 514-0732
Mailing address
PO BOX 456, BELEN, NM 87002-0456
(575) 835-4357
(505) 514-0732
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
05/30/2023
Last updated
07/03/2023
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