Active NPI
Maria Gonzales
- Speech-Language Pathologist
- Kirtland, NM
National Provider Identifier
1164850285
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 5405
- Practice address
- 31 Road 6195
Kirtland, NM 87417-9332 - Phone
- (505) 258-4560
- NPI assigned
- Oct 29, 2013
- Last updated
- Oct 29, 2013
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 5405 | NM | Primary |
Addresses
Primary practice location
31 Road 6195
Kirtland, NM 87417-9332
Mailing address
31 Road 6195
Kirtland, NM 87417-9332
Phone (505) 258-4560
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2129992021 | Medicaid | NM |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5405 | NM | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1383004800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1383004800000",
"number": "1164850285",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "31 ROAD 6195",
"city": "KIRTLAND",
"state": "NM",
"postal_code": "874179332",
"telephone_number": "505-258-4560"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "31 ROAD 6195",
"city": "KIRTLAND",
"state": "NM",
"postal_code": "874179332",
"telephone_number": "505-258-4560"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GONZALES",
"first_name": "MARIA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2013-10-29",
"last_updated": "2013-10-29",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "NM",
"license": "5405",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2129992021",
"state": "NM"
}
],
"endpoints": [],
"other_names": []
}Other providers in Kirtland, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.