Healthcare Provider Details

I. General information

NPI: 1912046939
Provider Name (Legal Business Name): YOLANDRA GOMEZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 03/04/2026
Certification Date: 03/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 HAWKS DR
DULCE NM
87528-5024
US

IV. Provider business mailing address

25 HAWKS DR
DULCE NM
87528-5024
US

V. Phone/Fax

Practice location:
  • Phone: 575-759-3242
  • Fax:
Mailing address:
  • Phone: 575-759-3242
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2004-0442
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD2007-0483
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: