Healthcare Provider Details

I. General information

NPI: 1396284485
Provider Name (Legal Business Name): TANIA L GONZALEZ BSN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TANIA L SERAFIN BSN RN

II. Dates (important events)

Enumeration Date: 02/22/2017
Last Update Date: 07/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 YALE BLVD SE
ALBUQUERQUE NM
87106
US

IV. Provider business mailing address

933 BRADBURY DR SE SUITE 2222
ALBUQUERQUE NM
87106-4374
US

V. Phone/Fax

Practice location:
  • Phone: 505-994-7999
  • Fax: 505-243-0366
Mailing address:
  • Phone: 505-272-3120
  • Fax: 505-272-8060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN80808
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: