Healthcare Provider Details

I. General information

NPI: 1912064205
Provider Name (Legal Business Name): MONICA GILBOA PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 ELM STREET, SW
ALBUQUERQUE NM
87102
US

IV. Provider business mailing address

2300 CAMINO DE LOS ARTESANO NW
ALBUQUERQUE NM
87107-2906
US

V. Phone/Fax

Practice location:
  • Phone: 505-727-3603
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number0846
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: