Healthcare Provider Details

I. General information

NPI: 1215852470
Provider Name (Legal Business Name): LIZETH GOMEZ AGUIRRE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 CHAPEL ST
NEW HAVEN CT
06511-4405
US

IV. Provider business mailing address

36 SOUTHWIND DR
WALLINGFORD CT
06492-5031
US

V. Phone/Fax

Practice location:
  • Phone: 203-680-6108
  • Fax:
Mailing address:
  • Phone: 203-680-6108
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: