1972127512 NPI number — STEPHANIE GONZALEZ DPM PA

Table of content: (NPI 1972127512)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972127512 NPI number — STEPHANIE GONZALEZ DPM PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STEPHANIE GONZALEZ DPM PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
STEPHANIE GONZALEZ, DPM, PA
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1972127512
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/23/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 221463
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EL PASO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79913-4463
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
575-680-2227
Provider Business Mailing Address Fax Number:
575-680-2228

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4151 CAMINO COYOTE STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAS CRUCES
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
88011-7096
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
575-680-2227
Provider Business Practice Location Address Fax Number:
575-680-2228
Provider Enumeration Date:
05/29/2020

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GONZALEZ
Authorized Official First Name:
STEPHANIE
Authorized Official Middle Name:
Authorized Official Title or Position:
PODIATRIST/OWNER
Authorized Official Telephone Number:
575-680-2227

Provider Taxonomy Codes

  • Taxonomy code: 261QP1100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)