Provider Demographics
NPI:1992945257
Name:GOMEZ-MEDLEY, LILIANA (MD)
Entity type:Individual
Prefix:DR
First Name:LILIANA
Middle Name:
Last Name:GOMEZ-MEDLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LILIANA
Other - Middle Name:DEL CARMEN
Other - Last Name:GOMEZ RAMIREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:10350 E DAKOTA AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80247-1314
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2345 BENT WAY
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80503-7614
Practice Address - Country:US
Practice Address - Phone:303-338-4545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-26
Last Update Date:2025-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0073927207Q00000X
FLME155284207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL114079000Medicaid
CO029601OtherKAISER COMMERCIAL NUMBER