Provider Demographics
NPI:1972127512
Name:STEPHANIE GONZALEZ DPM PA
Entity Type:Organization
Organization Name:STEPHANIE GONZALEZ DPM PA
Other - Org Name:STEPHANIE GONZALEZ, DPM, PA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PODIATRIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:575-680-2227
Mailing Address - Street 1:PO BOX 221463
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79913-4463
Mailing Address - Country:US
Mailing Address - Phone:575-680-2227
Mailing Address - Fax:575-680-2228
Practice Address - Street 1:4151 CAMINO COYOTE STE B
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-7096
Practice Address - Country:US
Practice Address - Phone:575-680-2227
Practice Address - Fax:575-680-2228
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STEPHANIE GONZALEZ DPM PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-05-29
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric