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NPI Code Detail

MEDICARE: DOREEN GONZALES

MEDICARE: DOREEN GONZALES
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist4342NM

General Provider Information

NPI Number : 1245629807
Entity Type Code : Individual
Provider Name (Legal Business Name) : DOREEN GONZALES
Provider Business Mailing Address
First Line : 9150 MCMAHON BLVD NW
Second Line :
City : ALBUQUERQUE
State : NM
Zip : 87114
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 9150 MCMAHON BLVD NW
Second Line :
City : ALBUQUERQUE
State : NM
Zip : 87114-5201
Country : US
Telephone Number : 505-898-7986
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/20/2015
Last Update Date : 06/05/2021

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Directions to “ DOREEN GONZALES ” Practice Location

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