Healthcare Provider Details

I. General information

NPI: 1104721224
Provider Name (Legal Business Name): RAQUEL GOMEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: RACHEL GOMEZ

II. Dates (important events)

Enumeration Date: 10/09/2026
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2410 E 110TH PL
NORTHGLENN CO
80233-4653
US

IV. Provider business mailing address

2410 E 110TH PL
NORTHGLENN CO
80233-4653
US

V. Phone/Fax

Practice location:
  • Phone: 720-301-1668
  • Fax:
Mailing address:
  • Phone: 720-301-1668
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171R00000X
TaxonomyInterpreter
License Number
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: