Most Relevant Information
Provider Data
| NPI Number: | 1003497272 |
| Provider Name: | FERMIN GONZALES CPSW, CCSS |
| Entity Type: | Individual |
| Taxonomy Code: | 175T00000X |
| Specialty: | Peer Specialist |
| License Number: | 1105 |
Most Important Dates
| Enumeration Date: | 04/19/2021 |
| Last Updated: | 04/19/2021 |
Provider Practice Location
9201 MONTGOMERY BLVD NE # 5
ALBUQUERQUE
NM
871112468
Practice Location Phone/Fax
| Phone: | 5052191919 |
| Fax: |
Provider Mailing Location
9201 MONTGOMERY BLVD NE # 5
ALBUQUERQUE
NM
871112468
Provider Mailing Phone/Fax
| Phone: | 5052191919 |
| Fax: |