Active NPI
Ken Gonzales, CPSW
- Peer Specialist
- Albuquerque, NM
National Provider Identifier
1336921394
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Peer Specialist
- License
- 1607
- Practice address
- 9201 Montgomery Blvd NE Ste V
Albuquerque, NM 87111-2470 - Phone
- (505) 507-7984
- NPI assigned
- Oct 16, 2023
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Peer Specialist | 175T00000X | 1607 | NM | Primary |
Addresses
Primary practice location
9201 Montgomery Blvd NE Ste V
Albuquerque, NM 87111-2470
Mailing address
9201 Montgomery Blvd NE Ste V
Albuquerque, NM 87111-2470
Phone (505) 507-7984
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 |
|---|---|---|---|
| 1607 | NM | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1697414400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1698019200000",
"number": "1336921394",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9201 MONTGOMERY BLVD NE STE V",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871112470",
"telephone_number": "505-507-7984"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9201 MONTGOMERY BLVD NE STE V",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871112470",
"telephone_number": "505-507-7984"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GONZALES",
"first_name": "KEN",
"credential": "CPSW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-10-16",
"last_updated": "2023-10-23",
"certification_date": "2023-10-23",
"status": "A"
},
"taxonomies": [
{
"code": "175T00000X",
"taxonomy_group": "",
"desc": "Peer Specialist",
"state": "NM",
"license": "1607",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Albuquerque, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.