| Doctor Name: | MRS. ELSA MARIE GONZALES |
| NPI Number: | 1043634207 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MSN, NP-C |
| License Number: | CNP-02354 |
| Business Practice Address: | 200 Emilio Lopez Rd Nw Los Lunas, NM - 870316818 |
| Business Phone Number: | 5058662700 |
| Business Fax Number: | 5058662701 |
| Mailing Address: | Po Box 26666, Phs Provider Enrollment ALBUQUERQUE |
| State: | NM |
| Postal Code: | 871256666 |
| Phone Number: | 5059236770 |
| Fax Number: | 5059235354 |
| NPI Enumeration Date: | 02/08/2014 |
| NPI Last Update Date: | 01/14/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | CNP-02354 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NM |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |