Healthcare Provider Details

I. General information

NPI: 1255749115
Provider Name (Legal Business Name): BECKY GONZALEZ CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2014
Last Update Date: 02/17/2026
Certification Date: 02/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3911 4TH ST NW STE B
ALBUQUERQUE NM
87107-2510
US

IV. Provider business mailing address

3911 4TH ST NW
ALBUQUERQUE NM
87107-2510
US

V. Phone/Fax

Practice location:
  • Phone: 505-433-4493
  • Fax: 505-433-5271
Mailing address:
  • Phone: 505-433-4493
  • Fax: 505-433-5271

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP-02477
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberCNP-02477
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: