Provider Demographics
NPI:1326933219
Name:GOMEZ, ROBERTO JR (RN)
Entity type:Individual
Prefix:
First Name:ROBERTO
Middle Name:
Last Name:GOMEZ
Suffix:JR
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2170 TRAWOOD DR APT 1002
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79935-3378
Mailing Address - Country:US
Mailing Address - Phone:915-309-4821
Mailing Address - Fax:
Practice Address - Street 1:3017 TRAWOOD DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-4330
Practice Address - Country:US
Practice Address - Phone:915-855-2005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-11
Last Update Date:2025-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX671994163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice