Healthcare Provider Details

I. General information

NPI: 1093428492
Provider Name (Legal Business Name): LAWRENCE EUGENE GOMES II DIRECT CARE WORKER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: LAWRENCE EUGENE GOMES II DIRECT CARE WORKER

II. Dates (important events)

Enumeration Date: 12/30/2022
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10933 W COTTONWOOD LN
AVONDALE AZ
85392-4322
US

IV. Provider business mailing address

10933 W COTTONWOOD LN
AVONDALE AZ
85392-4322
US

V. Phone/Fax

Practice location:
  • Phone: 602-616-0723
  • Fax:
Mailing address:
  • Phone: 602-616-0723
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License NumberNA
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: