Healthcare Provider Details

I. General information

NPI: 1164331575
Provider Name (Legal Business Name): ABRAHAM GOMEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2730 S VAL VISTA DR STE 177
GILBERT AZ
85295-1683
US

IV. Provider business mailing address

2730 S VAL VISTA DR STE 177
GILBERT AZ
85295-1683
US

V. Phone/Fax

Practice location:
  • Phone: 480-234-5052
  • Fax:
Mailing address:
  • Phone: 480-234-5052
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License NumberE3602691
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: