Provider Demographics
NPI:1033213681
Name:GONZALES, SHARON L (CASE MAANAGER)
Entity Type:Individual
Prefix:MS
First Name:SHARON
Middle Name:L
Last Name:GONZALES
Suffix:
Gender:F
Credentials:CASE MAANAGER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 TYLER STREET
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NM
Mailing Address - Zip Code:88415
Mailing Address - Country:US
Mailing Address - Phone:505-447-8153
Mailing Address - Fax:
Practice Address - Street 1:110 WALNUT STREET OFFICE B
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:NM
Practice Address - Zip Code:88415
Practice Address - Country:US
Practice Address - Phone:505-374-2032
Practice Address - Fax:505-374-0158
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist