Healthcare Provider Details

I. General information

NPI: 1700112323
Provider Name (Legal Business Name): OONA GONZALES DOM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2009
Last Update Date: 11/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2901 JUAN TABO BLVD NE STE 117
ALBUQUERQUE NM
87112-1885
US

IV. Provider business mailing address

2901 JUAN TABO BLVD NE STE 117
ALBUQUERQUE NM
87112-1885
US

V. Phone/Fax

Practice location:
  • Phone: 505-275-9602
  • Fax: 505-275-9604
Mailing address:
  • Phone: 505-275-9602
  • Fax: 505-275-9604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number1012
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: