Gonzales, Mike
Gonzales, Mike is an individual health care provider with primary practice located at 5601 Domingo Rd Ne , Albuquerque NM 87108-1610. He recently has only one registered license in Other Service Providers / Community Health Worker, which is considered as his primary health care specialty. Gonzales, Mike can be contacted via phone (505) 268-5295.Contact Information
Primary practice address
5601 Domingo Rd Ne
Albuquerque NM 87108-1610
Phone: (505) 268-5295
Fax: (505) 268-9967
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Other Service Providers / Community Health Worker | 172V00000X |
Profile Details
| NPI number | 1336372028 |
|---|---|
| LBN Legal business name | Gonzales, Mike |
| Credentials | |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Aug 27th, 2009 |
| Last updated | Aug 27th, 2009 - about 16 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1336372028 | NPPES |
| New Mexico | MEDICAID | B9311 |
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