Provider Demographics
NPI:1215642566
Name:GONZALES, BARBARA A (OWNER)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:A
Last Name:GONZALES
Suffix:
Gender:F
Credentials:OWNER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2208 MOLINE AVE
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81003-3810
Mailing Address - Country:US
Mailing Address - Phone:719-406-6487
Mailing Address - Fax:
Practice Address - Street 1:2208 MOLINE AVE
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81003-3810
Practice Address - Country:US
Practice Address - Phone:719-406-6487
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-20
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)