Provider Demographics
NPI:1770478729
Name:GONZALES, ASHLEY (CHW)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:GONZALES
Suffix:
Gender:F
Credentials:CHW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12208 MIRANDY CT NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87122-1274
Mailing Address - Country:US
Mailing Address - Phone:505-221-6212
Mailing Address - Fax:505-221-5551
Practice Address - Street 1:12208 MIRANDY CT NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87122-1274
Practice Address - Country:US
Practice Address - Phone:505-221-6212
Practice Address - Fax:505-221-5551
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-10
Last Update Date:2025-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMG-1547172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker