Healthcare Provider Details

I. General information

NPI: 1376988444
Provider Name (Legal Business Name): NADIA GOMEZ-MORAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NADIA GOMEZ

II. Dates (important events)

Enumeration Date: 05/02/2013
Last Update Date: 05/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1820 S 25TH AVE
BROADVIEW IL
60155-2864
US

IV. Provider business mailing address

2212 ATLANTIC AVE
MELROSE PARK IL
60164-2109
US

V. Phone/Fax

Practice location:
  • Phone: 708-681-0073
  • Fax:
Mailing address:
  • Phone: 773-575-9450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: