Healthcare Provider Details

I. General information

NPI: 1871045120
Provider Name (Legal Business Name): JUNTOS PODEMOS INC II
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2016
Last Update Date: 11/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2715 4TH ST NW
ALBUQUERQUE NM
87107-1329
US

IV. Provider business mailing address

5836 IRVING BLVD NW
ALBUQUERQUE NM
87114-4839
US

V. Phone/Fax

Practice location:
  • Phone: 505-242-4533
  • Fax: 505-242-4240
Mailing address:
  • Phone: 505-234-9614
  • Fax: 505-242-4240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number3659
License Number StateNM

VIII. Authorized Official

Name: MR. MIGUEL GONZALES
Title or Position: COUNSELOR
Credential: SUBSTANCE ABUSE ASSI
Phone: 505-234-9614