Healthcare Provider Details

I. General information

NPI: 1609606276
Provider Name (Legal Business Name): GABRIELA GOMES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2024
Last Update Date: 08/07/2024
Certification Date: 08/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 COLONIAL DR STE D
BATON ROUGE LA
70806-6549
US

IV. Provider business mailing address

101 RIVER HOUSE PL APT 1403
BATON ROUGE LA
70802-7674
US

V. Phone/Fax

Practice location:
  • Phone: 786-557-5436
  • Fax:
Mailing address:
  • Phone: 786-557-5436
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: