Provider Demographics
NPI:1598028268
Name:GONZALES, FELIX OLMEDO JR (ORDAINED PASTOR)
Entity Type:Individual
Prefix:MR
First Name:FELIX
Middle Name:OLMEDO
Last Name:GONZALES
Suffix:JR
Gender:M
Credentials:ORDAINED PASTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3260 VENUS ST
Mailing Address - Street 2:#41
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88012-7753
Mailing Address - Country:US
Mailing Address - Phone:575-386-2944
Mailing Address - Fax:
Practice Address - Street 1:1530 E. ARIZONA ST.
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001
Practice Address - Country:US
Practice Address - Phone:575-386-2944
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-19
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMNOT LICENSED101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral