Provider Demographics
NPI:1417745340
Name:GONZALES, STEPHEN MARCOS
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:MARCOS
Last Name:GONZALES
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6723 PIEDRA ASPERO ST NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-7144
Mailing Address - Country:US
Mailing Address - Phone:505-270-1458
Mailing Address - Fax:
Practice Address - Street 1:6723 PIEDRA ASPERO ST NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120-7144
Practice Address - Country:US
Practice Address - Phone:505-270-1458
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-29
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician