Healthcare Provider Details

I. General information

NPI: 1164910568
Provider Name (Legal Business Name): PATRICIA D GONZALEZ RVT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2018
Last Update Date: 05/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3850 FOOTHILLS RD STE 3
LAS CRUCES NM
88011-4632
US

IV. Provider business mailing address

PO BOX 13271
LAS CRUCES NM
88013-3271
US

V. Phone/Fax

Practice location:
  • Phone: 575-522-5511
  • Fax: 575-522-0825
Mailing address:
  • Phone: 575-932-9350
  • Fax: 575-522-0825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246XC2903X
TaxonomyVascular Specialist/Technologist Cardiovascular
License Number305S00000X
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code246XC2903X
TaxonomyVascular Specialist/Technologist Cardiovascular
License Number111388
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: