Provider Demographics
NPI:1629342324
Name:GONZALES, LUZ (OTR)
Entity Type:Individual
Prefix:
First Name:LUZ
Middle Name:
Last Name:GONZALES
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2217 DILLON RD
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:NM
Mailing Address - Zip Code:88101-9454
Mailing Address - Country:US
Mailing Address - Phone:575-769-7356
Mailing Address - Fax:575-769-7289
Practice Address - Street 1:2217 DILLON RD
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:NM
Practice Address - Zip Code:88101-9454
Practice Address - Country:US
Practice Address - Phone:575-769-7356
Practice Address - Fax:575-769-7289
Is Sole Proprietor?:No
Enumeration Date:2012-02-28
Last Update Date:2012-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2896225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist