Healthcare Provider Details

I. General information

NPI: 1871215723
Provider Name (Legal Business Name): CHRISTOPHER LUIS GOMEZ APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: CHRISTOPHER LUIS GOMEZ APRN

II. Dates (important events)

Enumeration Date: 09/16/2022
Last Update Date: 09/16/2022
Certification Date: 08/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 W FOREST AVE STE 201
FLAGSTAFF AZ
86001-1483
US

IV. Provider business mailing address

401 N BERTRAND ST
FLAGSTAFF AZ
86001-4702
US

V. Phone/Fax

Practice location:
  • Phone: 928-773-2222
  • Fax: 928-773-2598
Mailing address:
  • Phone: 928-380-1439
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number280966
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: