Individual
SUSANNA MARIE GONZALES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1100 CENTRAL AVE SE FL 4, PMG INTENSIVISTS, ALBUQUERQUE, NM 87106-4930
(505) 724-6145
Mailing address
PO BOX 26666, PHS PROVIDER ENROLLMENT, ALBUQUERQUE, NM 87125-6666
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
20020465
NM
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
Primary
2002-0465
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
71639527
—
NM
Enumeration date
10/03/2006
Last updated
06/02/2016
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