Provider Demographics
NPI:1124747597
Name:GONZALEZ, ANGEL COLLEEN (RECRATIONAL THERAPY)
Entity type:Individual
Prefix:MS
First Name:ANGEL
Middle Name:COLLEEN
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:RECRATIONAL THERAPY
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:7345 S DURANGO DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-3653
Mailing Address - Country:US
Mailing Address - Phone:253-365-0900
Mailing Address - Fax:
Practice Address - Street 1:2595 S JONES BLVD
Practice Address - Street 2:SUITE 2F
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-0000
Practice Address - Country:US
Practice Address - Phone:702-806-9143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-26
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation TherapistGroup - Multi-Specialty
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No175T00000XOther Service ProvidersPeer Specialist
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies