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NPI Code Detail

MEDICARE: RENE GONZALEZ MD

MEDICARE: RENE GONZALEZ MD
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
12084P0800XPsychiatry Physician86-234NM

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1659512309
Entity Type Code : Individual
Provider Name (Legal Business Name) : RENE GONZALEZ MD
Provider Business Mailing Address
First Line : 707 BROADWAY BLVD NE STE 500
Second Line :
City : ALBUQUERQUE
State : NM
Zip : 87102-2367
Country : US
Telephone Number : 505-232-9055
Fax Number :
Provider Business Practice Location Address
First Line : 4201 CARLISLE BLVD NE
Second Line :
City : ALBUQUERQUE
State : NM
Zip : 87107-4808
Country : US
Telephone Number : 505-750-2034
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/10/2009
Last Update Date : 03/04/2019

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