Healthcare Provider Details

I. General information

NPI: 1508939687
Provider Name (Legal Business Name): RICARDO GONZALEZ CNS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 05/12/2021
Certification Date: 05/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1551 MONTANA AVE
EL PASO TX
79902-5668
US

IV. Provider business mailing address

6704 DAKOTA RIDGE DR
EL PASO TX
79912-8115
US

V. Phone/Fax

Practice location:
  • Phone: 915-747-3510
  • Fax:
Mailing address:
  • Phone: 915-584-5008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License NumberAP114437
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: