Provider Demographics
NPI:1336127653
Name:CABALLAR GONZAGA, FLOR J (MD)
Entity Type:Individual
Prefix:
First Name:FLOR
Middle Name:J
Last Name:CABALLAR GONZAGA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1070 RANCHO RD
Mailing Address - Street 2:
Mailing Address - City:GALLUP
Mailing Address - State:NM
Mailing Address - Zip Code:87301-7036
Mailing Address - Country:US
Mailing Address - Phone:505-863-7000
Mailing Address - Fax:
Practice Address - Street 1:1211 E AZTEC AVE
Practice Address - Street 2:
Practice Address - City:GALLUP
Practice Address - State:NM
Practice Address - Zip Code:87301-4901
Practice Address - Country:US
Practice Address - Phone:505-863-1820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2011-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM97-232084S0012X, 2084N0600X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ386161OtherAHCCCS
NMNM013076OtherBC/BS
NMPROVP12052OtherMOLINA
NMQ2996Medicaid
201014109OtherPRESBYTERIAN HEALTH/SALUD
370010516OtherRAILROAD MEDICARE
NM10002253OtherLOVELACE HEALTH/SALUD
85031326887301A136OtherCHAMPUS
201014109OtherPRESBYTERIAN HEALTH/SALUD
NM345512701Medicare ID - Type Unspecified