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NPI Code Detail

MEDICARE: MAHDEVI C GONZALEZ BA

MEDICARE: MAHDEVI C GONZALEZ BA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1IDKOTHERAZUMR

General Provider Information

NPI Number : 1083370738
Entity Type Code : Individual
Provider Name (Legal Business Name) : MAHDEVI C GONZALEZ BA
Provider Business Mailing Address
First Line : 3131 N COUNTRY CLUB RD STE 100
Second Line :
City : TUCSON
State : AZ
Zip : 85716-1650
Country : US
Telephone Number : 520-229-6220
Fax Number :
Provider Business Practice Location Address
First Line : 3131 N COUNTRY CLUB RD STE 100
Second Line :
City : TUCSON
State : AZ
Zip : 85716-1650
Country : US
Telephone Number : 520-229-6220
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/16/2021
Last Update Date : 11/16/2021

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Directions to “ MAHDEVI C GONZALEZ BA” Practice Location

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