Healthcare Provider Details

I. General information

NPI: 1720908262
Provider Name (Legal Business Name): MALILLANY D GOMEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2026
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 S CLEBURN ST APT 1
GRAND ISLAND NE
68801-6575
US

IV. Provider business mailing address

403 S ADAMS ST
LEXINGTON NE
68850-2305
US

V. Phone/Fax

Practice location:
  • Phone: 402-695-5121
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: