Provider Demographics
NPI:1164705372
Name:NAVA-GONZALEZ, SANDRA (CF)
Entity Type:Individual
Prefix:MISS
First Name:SANDRA
Middle Name:
Last Name:NAVA-GONZALEZ
Suffix:
Gender:F
Credentials:CF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2135 PAYNE ST
Mailing Address - Street 2:APT 306
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88001-5886
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2135 PAYNE ST
Practice Address - Street 2:APT 306
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-5886
Practice Address - Country:US
Practice Address - Phone:575-621-9026
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-23
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMC-5004235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist