Provider Demographics
NPI:1063158251
Name:TEIXEIRA GOMES, CLAUDIA L (PA-S)
Entity type:Individual
Prefix:
First Name:CLAUDIA
Middle Name:L
Last Name:TEIXEIRA GOMES
Suffix:
Gender:F
Credentials:PA-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3828 W PRAIRIE DUNES DR APT 17D
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84084-1874
Mailing Address - Country:US
Mailing Address - Phone:801-783-0288
Mailing Address - Fax:
Practice Address - Street 1:3828 W PRAIRIE DUNES DR APT 17D
Practice Address - Street 2:
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84084-1874
Practice Address - Country:US
Practice Address - Phone:801-783-0288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-10
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program