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Mr. Martin Gonzales
Child Mental Illness Respite Care in Phoenix, Arizona
NPI 1477627495

Martin Gonzales is a Child Mental Illness Respite Care based in Phoenix, AZ and is specialized in Respite Care, Mental Illness, Child. Martin Gonzales practices in Phoenix, AZ. The NPI Number for Martin Gonzales is 1477627495 and holds a License No. 8896 (Arizona).

The current practice location address for Martin Gonzales is 3924 W Maricopa St, Phoenix, AZ and can be reached out via phone at 602-353-9352.

Location: 3924 W Maricopa St, Phoenix, AZ, 85009-5410
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1477627495
Provider Name
Martin Gonzales
Credential
Provider Entity Type
Individual
Gender
Male
Address
3924 W Maricopa St, Phoenix, AZ, 85009-5410
Phone Number
602-353-9352
Fax Number
Provider Enumeration Date
11/20/2006
Last Update Date
03/08/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
910035 01 AZ AHCCCS ID NUMBER
institution
Provider Business Practice Location Address Details
Address
3924 W Maricopa St
City
Phoenix
State
Arizona
Zip
85009-5410
Phone Number
602-353-9352
Fax Number
person
Provider Business Mailing Address Details
Address
3924 W Maricopa St
City
Phoenix
State
Arizona
Zip
85009-5410
Phone Number
602-353-9352
Fax Number
person
Provider's Taxonomy Details 1
Type
Respite Care Facility
Classification
Respite Care
Speciality
Respite Care, Mental Illness, Child
Taxonomy
385HR2055X
License No.
8896 (Arizona)
Definition
A facility or distinct part of a facility that provides short term, residential care to children, diagnosed with mental illness, as respite for the regular caregivers.
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