Provider Demographics
NPI:1992280069
Name:GOMEZ, MARIA S (LVN)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:S
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 PATRICK ST APT 17
Mailing Address - Street 2:
Mailing Address - City:WAXAHACHIE
Mailing Address - State:TX
Mailing Address - Zip Code:75165-2900
Mailing Address - Country:US
Mailing Address - Phone:214-949-3843
Mailing Address - Fax:
Practice Address - Street 1:208 PATRICK ST APT 17
Practice Address - Street 2:
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165-2900
Practice Address - Country:US
Practice Address - Phone:214-949-3843
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-25
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX345153164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse