Provider Demographics
NPI:1194715938
Name:GONZALEZ, DIEGO J (MD)
Entity type:Individual
Prefix:DR
First Name:DIEGO
Middle Name:J
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8100 WYOMING BLVD NE # M4308
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87113-1946
Mailing Address - Country:US
Mailing Address - Phone:505-633-4141
Mailing Address - Fax:505-243-4804
Practice Address - Street 1:8300 CARMEL AVE NE STE 500-501
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87122-3147
Practice Address - Country:US
Practice Address - Phone:505-633-4141
Practice Address - Fax:505-633-4144
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NM2004-0201207L00000X, 207LP2900X
NMMD2004-0201208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM58830839Medicaid
NMI07132Medicare UPIN
NM58830839Medicaid