Healthcare Provider Details

I. General information

NPI: 1225815566
Provider Name (Legal Business Name): MARIA ESTELA GONZALEZ CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2023
Last Update Date: 09/11/2023
Certification Date: 09/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1608 ISLETA BLVD SW
ALBUQUERQUE NM
87105-4634
US

IV. Provider business mailing address

1608 ISLETA BLVD SW
ALBUQUERQUE NM
87105-4634
US

V. Phone/Fax

Practice location:
  • Phone: 505-907-8311
  • Fax: 505-288-3561
Mailing address:
  • Phone: 505-907-8311
  • Fax: 505-288-3561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number75501
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: