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General NPI Number Information
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NPI Number | 1093297392
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Entity Type | Individual
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Provider Name | GILBERTO CONTRERAS
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Gender | Male
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Dates
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Enumeration Date | 09/04/2018
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Last Update Date | 03/11/2020
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Provider Practice Location Address
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Address Line | 9146 W SLATE MOUNTAIN TRAIL
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City | BELLEMONT
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State | AZ
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Zip | 86015
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Country | US
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Telephone | 928-607-3598
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Fax |
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Provider Business Mailing Address
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Address Line | 2323 E GREENLAW LN STE 10B
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City | FLAGSTAFF
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State | AZ
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Zip | 86004-1849
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Country | US
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Telephone | 928-226-1097
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 385HR2055X
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Taxonomy Name | Child Mental Illness Respite Care
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 253J00000X
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Taxonomy Name | Foster Care Agency
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License Number | 9314517
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License Number State | AZ
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