Healthcare Provider Details

I. General information

NPI: 1386589422
Provider Name (Legal Business Name): JACINDA GOMEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2256 SAN FELIPE
LAS CRUCES NM
88011-9058
US

IV. Provider business mailing address

2256 SAN FELIPE
LAS CRUCES NM
88011-9058
US

V. Phone/Fax

Practice location:
  • Phone: 915-408-3776
  • Fax:
Mailing address:
  • Phone: 915-408-3776
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCTB-20260325
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: