=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922929678
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RIO GRANDE TMS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/21/2026
-----------------------------------------------------
Last Update Date | 07/21/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3911 4TH ST NW
-----------------------------------------------------
City | ALBUQUERQUE
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87107-2510
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-433-4493
-----------------------------------------------------
Fax | 505-433-5271
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3911 4TH ST NW
-----------------------------------------------------
City | ALBUQUERQUE
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87107-2510
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-433-4493
-----------------------------------------------------
Fax | 505-433-5271
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PROVIDER/ OWNER
-----------------------------------------------------
Name | BECKY GONZALEZ CNP
-----------------------------------------------------
Credential | FNP,PMHNP
-----------------------------------------------------
Telephone | 505-433-4493
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------