Provider Demographics
NPI:1376925883
Name:GONZALES, DEBORAH ANN
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:ANN
Last Name:GONZALES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2445 W SILVER SAGE LN
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85085-5740
Mailing Address - Country:US
Mailing Address - Phone:623-847-8839
Mailing Address - Fax:623-847-8838
Practice Address - Street 1:11215 W NEVADA AVE
Practice Address - Street 2:STE C
Practice Address - City:YOUNGTOWN
Practice Address - State:AZ
Practice Address - Zip Code:85363-1244
Practice Address - Country:US
Practice Address - Phone:623-847-8839
Practice Address - Fax:623-847-8838
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-19
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744R1102XOther Service ProvidersSpecialistResearch Study