Healthcare Provider Details

I. General information

NPI: 1740113109
Provider Name (Legal Business Name): JAYLIN LORENZO GOMEZ MHP
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2026
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1752 CAPITAL ST
ELGIN IL
60124-7896
US

IV. Provider business mailing address

152 S JANE DR
ELGIN IL
60123-5912
US

V. Phone/Fax

Practice location:
  • Phone: 847-695-3680
  • Fax:
Mailing address:
  • Phone: 224-828-3010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: