Healthcare Provider Details

I. General information

NPI: 1144200288
Provider Name (Legal Business Name): DEBRA GONZALES RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2006
Last Update Date: 11/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 N COUNTRY CLUB DR
MESA AZ
85201-3307
US

IV. Provider business mailing address

1025 N COUNTRY CLUB DR
MESA AZ
85201-3307
US

V. Phone/Fax

Practice location:
  • Phone: 480-472-7876
  • Fax: 480-472-7878
Mailing address:
  • Phone: 480-472-7876
  • Fax: 480-472-7878

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberRN060517
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: