Provider Demographics
NPI:1114164795
Name:GONZALES-APODACA, SALLY (CPA)
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:
Last Name:GONZALES-APODACA
Suffix:
Gender:F
Credentials:CPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1080 CHINOOK LN
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81001-1850
Mailing Address - Country:US
Mailing Address - Phone:719-564-9400
Mailing Address - Fax:719-564-0497
Practice Address - Street 1:1339 S PUEBLO BLVD
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81005-1686
Practice Address - Country:US
Practice Address - Phone:719-564-9400
Practice Address - Fax:719-564-0497
Is Sole Proprietor?:No
Enumeration Date:2009-01-19
Last Update Date:2018-01-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO117363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant