Healthcare Provider Details

I. General information

NPI: 1053528430
Provider Name (Legal Business Name): MS. CLAUDIA G. GOMEZ MARTINEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 N 3RD ST SUITE 200
PHOENIX AZ
85004-3924
US

IV. Provider business mailing address

3432 W MCNEIL DR
LAVEEN AZ
85339-1791
US

V. Phone/Fax

Practice location:
  • Phone: 602-528-3439
  • Fax:
Mailing address:
  • Phone: 602-237-7270
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number2369
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: