Individual
ELISSIA GONZALEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5200 COPPER AVE NE, ALBUQUERQUE, NM 87108-1473
(505) 266-5557
Mailing address
8809 COMANCHE RD NE, ALBUQUERQUE, NM 87111-3363
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
3456
NM
Other
Enumeration date
08/11/2017
Last updated
08/11/2017
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