Provider Demographics
NPI:1285259572
Name:GONZALEZ, CAMEO (LMT)
Entity type:Individual
Prefix:
First Name:CAMEO
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1491 DENVER AVE UNIT 101
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-5228
Mailing Address - Country:US
Mailing Address - Phone:970-663-2225
Mailing Address - Fax:970-593-6748
Practice Address - Street 1:1491 DENVER AVE UNIT 101
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-5228
Practice Address - Country:US
Practice Address - Phone:970-663-2225
Practice Address - Fax:970-593-6748
Is Sole Proprietor?:No
Enumeration Date:2020-06-11
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT.0021838225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist