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General NPI Number Information
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NPI Number | 1821150756
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Entity Type | Individual
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Provider Name | PHYLLIS NADINE GONZALES DC, BSN-RN
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Gender | Female
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Dates
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Enumeration Date | 12/15/2006
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Last Update Date | 03/10/2015
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Provider Practice Location Address
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Address Line | 219 WASHINGTON AVENUE
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City | SANTA FE
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State | NM
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Zip | 87501-1926
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Country | US
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Telephone | 505-946-7677
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Fax | 505-986-1569
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Provider Business Mailing Address
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Address Line | 121 CAMINO ENCANTADO
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City | SANTA FE
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State | NM
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Zip | 87501-1039
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Country | US
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Telephone | 505-946-7677
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Fax | 505-986-1569
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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 | 111NR0400X
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Taxonomy Name | Rehabilitation Chiropractor
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License Number | 1318
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 111NR0400X
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Taxonomy Name | Rehabilitation Chiropractor
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License Number | 4766
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License Number State | CO
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Taxonomy #3
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Taxonomy Code | 111NR0400X
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Taxonomy Name | Rehabilitation Chiropractor
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License Number | DC-29335
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License Number State | CA
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