MEDICARE: LIZBETH GONZALEZ SWC

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	376K00000X	Nurse's Aide	NA00737225	CO
2	104100000X	Social Worker	SWC.0000000707	CO

General Provider Information

NPI Number	:	1831505486
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LIZBETH GONZALEZ SWC

Provider Business Mailing Address
First Line	:	5720 W COUNTY ROAD 54 E
Second Line	:
City	:	BELLVUE
State	:	CO
Zip	:	80512-7122
Country	:	US
Telephone Number	:	970-308-0473
Fax Number	:

Provider Business Practice Location Address
First Line	:	1301 RIVERSIDE AVE
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80524-4374
Country	:	US
Telephone Number	:	970-888-4070
Fax Number	:

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

Provider Enumeration Date	:	07/03/2014
Last Update Date	:	07/24/2024

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