Healthcare Provider Details

I. General information

NPI: 1992850325
Provider Name (Legal Business Name): RACHEAL FLORES GONZALES LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 05/06/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 LASER DR NE
RIO RANCHO NM
87124-4517
US

IV. Provider business mailing address

213 2ND ST NE
RIO RANCHO NM
87124-0726
US

V. Phone/Fax

Practice location:
  • Phone: 505-892-2575
  • Fax:
Mailing address:
  • Phone: 505-892-2575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number295279
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberC-08851
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: