Provider Demographics
NPI:1467006551
Name:GONZALES, ANGELA DAWN (CSW)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:DAWN
Last Name:GONZALES
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 ARMIJO LN
Mailing Address - Street 2:
Mailing Address - City:BERNALILLO
Mailing Address - State:NM
Mailing Address - Zip Code:87004-8038
Mailing Address - Country:US
Mailing Address - Phone:505-923-0273
Mailing Address - Fax:
Practice Address - Street 1:301 S CAMINO DEL PUEBLO
Practice Address - Street 2:
Practice Address - City:BERNALILLO
Practice Address - State:NM
Practice Address - Zip Code:87004-6276
Practice Address - Country:US
Practice Address - Phone:505-837-2383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-28
Last Update Date:2019-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist