MEDICARE: BECKY GONZALEZ CNP

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
1	363LF0000X	Family Nurse Practitioner	CNP-02477	NM
2	2084P0800X	Psychiatry Physician	CNP-02477	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1255749115	OTHER	NM	NPI
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255749115
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BECKY GONZALEZ CNP

Provider Business Mailing Address
First Line	:	3911 4TH ST NW
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87107-2510
Country	:	US
Telephone Number	:	505-433-4493
Fax Number	:	505-433-5271

Provider Business Practice Location Address
First Line	:	3911 4TH ST NW STE B
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87107-2510
Country	:	US
Telephone Number	:	505-433-4493
Fax Number	:	505-433-5271

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/23/2014
Last Update Date	:	02/17/2026

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