Provider Demographics
NPI:1740573823
Name:GONZALES, ARMIDA BONDOC
Entity Type:Individual
Prefix:
First Name:ARMIDA
Middle Name:BONDOC
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 1:15 S MAPLE AVE
Mailing Address - Street 2:APT 2
Mailing Address - City:LA PLATA
Mailing Address - State:MD
Mailing Address - Zip Code:20646-6901
Mailing Address - Country:US
Mailing Address - Phone:240-319-2419
Mailing Address - Fax:
Practice Address - Street 1:15 S MAPLE AVE
Practice Address - Street 2:APT 2
Practice Address - City:LA PLATA
Practice Address - State:MD
Practice Address - Zip Code:20646
Practice Address - Country:US
Practice Address - Phone:240-319-2419
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-23
Last Update Date:2011-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD23148225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist