Provider Demographics
NPI:1699468579
Name:GONZALES, CONCEPTION P (CMT/LMT)
Entity type:Individual
Prefix:
First Name:CONCEPTION
Middle Name:P
Last Name:GONZALES
Suffix:
Gender:F
Credentials:CMT/LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3807 FLOWERFIELD RD APT A
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23518-4700
Mailing Address - Country:US
Mailing Address - Phone:808-600-1771
Mailing Address - Fax:
Practice Address - Street 1:9573 SHORE DR
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23518-1722
Practice Address - Country:US
Practice Address - Phone:808-600-1771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-29
Last Update Date:2023-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019018555225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist