| Jared J. Gonzales Llc | |
|
1395 Missouri Ave Las Cruces NM 88001-5327 | |
| (575) 522-5466 | |
| Not Available |
| Full Name | Jared J. Gonzales Llc |
|---|---|
| Speciality | Psychologist |
| Location | 1395 Missouri Ave, Las Cruces, New Mexico |
| Authorized Official Name and Position | Jared Gonzales (PSYCHOLOGIST) |
| Authorized Official Contact | 5756214304 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jared J. Gonzales Llc 4672 Mesita St Las Cruces NM 88012-6329 Ph: (575) 621-4304 | Jared J. Gonzales Llc 1395 Missouri Ave Las Cruces NM 88001-5327 Ph: (575) 522-5466 |
| NPI Number | 1245963651 |
|---|---|
| Provider Enumeration Date | 07/04/2022 |
| Last Update Date | 07/04/2022 |
| Certification Date | 07/04/2022 |
| Medicare PECOS PAC ID | 6709254386 |
|---|---|
| Medicare Enrollment ID | O20221202000472 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245963651 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | (* (Not Available)) | Primary |
| Provider Name | Jared J Gonzales |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1801224332 PECOS PAC ID: 0244600641 Enrollment ID: I20221229001430 |
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