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General NPI Number Information
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NPI Number | 1912064205
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Entity Type | Individual
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Provider Name | MONICA GILBOA PH.D.
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Gender | Female
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Dates
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Enumeration Date | 01/03/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 505 ELM STREET, SW
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City | ALBUQUERQUE
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State | NM
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Zip | 87102
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Country | US
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Telephone | 505-727-3603
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Fax |
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Provider Business Mailing Address
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Address Line | 2300 CAMINO DE LOS ARTESANO NW
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City | ALBUQUERQUE
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State | NM
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Zip | 87107-2906
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Country | US
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Telephone |
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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 | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 0846
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License Number State | NM
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