Healthcare Provider Details

I. General information

NPI: 1013389238
Provider Name (Legal Business Name): JULIA GONZALEZ M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2015
Last Update Date: 10/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2019 GALISTEO ST SUITE D-2
SANTA FE NM
87505-2143
US

IV. Provider business mailing address

2491 SAWMILL RD APT 1905
SANTA FE NM
87505-5680
US

V. Phone/Fax

Practice location:
  • Phone: 575-973-5112
  • Fax:
Mailing address:
  • Phone: 575-973-5112
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: