Provider Demographics
NPI:1083196190
Name:ALVARADO GOMEZ, JASSON
Entity type:Individual
Prefix:
First Name:JASSON
Middle Name:
Last Name:ALVARADO GOMEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 FRANK B MURRAY ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01103-1106
Mailing Address - Country:US
Mailing Address - Phone:508-723-5893
Mailing Address - Fax:
Practice Address - Street 1:15 WOODMAN RD
Practice Address - Street 2:APT 3
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01602-2932
Practice Address - Country:US
Practice Address - Phone:508-723-5893
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-05
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program