Healthcare Provider Details

I. General information

NPI: 1619801909
Provider Name (Legal Business Name): MERSADEZ GOMEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1928 S DAN JONES RD
AVON IN
46123-6678
US

IV. Provider business mailing address

426 ANDES RD
PLAINFIELD IN
46168-5855
US

V. Phone/Fax

Practice location:
  • Phone: 317-854-8265
  • Fax:
Mailing address:
  • Phone: 317-854-8265
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: