Provider Demographics
NPI:1770068967
Name:GONZALEZ, MICHELLE (AC)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 BARTLETT DR
Mailing Address - Street 2:BLDG A
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-1607
Mailing Address - Country:US
Mailing Address - Phone:915-600-2905
Mailing Address - Fax:
Practice Address - Street 1:211 BARTLETT DR
Practice Address - Street 2:BLDG A
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-1607
Practice Address - Country:US
Practice Address - Phone:915-600-2905
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-03
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC01699171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist