Provider Demographics
NPI:1730863416
Name:HALEY GONZALEZ
Entity type:Organization
Organization Name:HALEY GONZALEZ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIETITIAN-OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:HALEY
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RD, LD
Authorized Official - Phone:501-276-1342
Mailing Address - Street 1:103 SAINT CHARLES CT
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71901-7958
Mailing Address - Country:US
Mailing Address - Phone:501-276-1342
Mailing Address - Fax:
Practice Address - Street 1:216 GARRISON ST STE B
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913-7319
Practice Address - Country:US
Practice Address - Phone:501-276-1342
Practice Address - Fax:501-463-4042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-13
Last Update Date:2023-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty