Provider Information for 1801224332
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Dr. JARED GONZALES
Sex: Male
NPI: 1801224332
Last Updated: 2022-10-13
Certification Date: 2022-10-13
Certification Date: 2022-10-13
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1801224332 | ||||||||||||
| Enumeration Date | 2013-10-18 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | NO | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 4672 MESITA ST LAS CRUCES, NM 88012-6329 United States Phone: | Fax: | ||||||||||||
| Primary Practice Address | 1395 MISSOURI AVE LAS CRUCES, NM 88001-5327 United States Phone: 575-621-4304 | Fax: | ||||||||||||
| Secondary Practice Address(es) | 505 S MAIN ST STE 249 | ||||||||||||
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