Provider Demographics
NPI:1902353998
Name:GONZALES, MONICA S (OD)
Entity type:Individual
Prefix:DR
First Name:MONICA
Middle Name:S
Last Name:GONZALES
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:10224 COORS BYP NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-4398
Mailing Address - Country:US
Mailing Address - Phone:505-898-9160
Mailing Address - Fax:505-898-9759
Practice Address - Street 1:10224 COORS BYP NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114-4398
Practice Address - Country:US
Practice Address - Phone:505-898-9160
Practice Address - Fax:505-898-9759
Is Sole Proprietor?:No
Enumeration Date:2016-09-07
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM684152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist