Provider Demographics
NPI:1942044326
Name:GONZALES, MARIA TERESA (AGNP-C)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:TERESA
Last Name:GONZALES
Suffix:
Gender:F
Credentials:AGNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 25335
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-0105
Mailing Address - Country:US
Mailing Address - Phone:408-457-4819
Mailing Address - Fax:
Practice Address - Street 1:1400 S DOBSON RD # B-122
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-4707
Practice Address - Country:US
Practice Address - Phone:602-314-4432
Practice Address - Fax:602-324-2308
Is Sole Proprietor?:No
Enumeration Date:2024-06-21
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAG06240016363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology