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NPI Code Detail

MEDICARE: EDWARDO GONZALES MED

MEDICARE: EDWARDO GONZALES MED
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 CounselorRC00036825WA

General Provider Information

NPI Number : 1699718718
Entity Type Code : Individual
Provider Name (Legal Business Name) : EDWARDO GONZALES MED
Provider Business Mailing Address
First Line : 9411 BENJAMIN WAY SE
Second Line :
City : MOSES LAKE
State : WA
Zip : 98837-8319
Country : US
Telephone Number : 509-765-9239
Fax Number : 509-765-1582
Provider Business Practice Location Address
First Line : 840 E PLUM ST
Second Line :
City : MOSES LAKE
State : WA
Zip : 98837-1874
Country : US
Telephone Number : 509-765-9239
Fax Number : 509-765-1582
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/14/2006
Last Update Date : 07/08/2007

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Directions to “ EDWARDO GONZALES MED” Practice Location

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