Provider Demographics
NPI:1164910568
Name:GONZALEZ, PATRICIA D (RVT)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:D
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:RVT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 13271
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88013-3271
Mailing Address - Country:US
Mailing Address - Phone:575-932-9350
Mailing Address - Fax:575-522-0825
Practice Address - Street 1:3850 FOOTHILLS RD STE 3
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-4632
Practice Address - Country:US
Practice Address - Phone:575-522-5511
Practice Address - Fax:575-522-0825
Is Sole Proprietor?:No
Enumeration Date:2018-05-01
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM305S00000X246XC2903X
NM111388246XC2903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246XC2903XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularVascular Specialist