Provider Demographics
NPI:1972340594
Name:GONZALES, ANNA MARIA
Entity type:Individual
Prefix:PROF
First Name:ANNA
Middle Name:MARIA
Last Name:GONZALES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 2ND ST
Mailing Address - Street 2:
Mailing Address - City:HUACHUCA CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:85616-9711
Mailing Address - Country:US
Mailing Address - Phone:520-249-7944
Mailing Address - Fax:
Practice Address - Street 1:155 EL CAMINO REAL STE A
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-2823
Practice Address - Country:US
Practice Address - Phone:520-249-7944
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-11
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT-08746225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty