Healthcare Provider Details

I. General information

NPI: 1992048243
Provider Name (Legal Business Name): ROBERTO MATTHEW GOMEZ PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2013
Last Update Date: 03/19/2025
Certification Date: 03/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 OTERO RD
LOS LUNAS NM
87031-5707
US

IV. Provider business mailing address

100 CARSON DR SE UNIT 1601
LOS LUNAS NM
87031-3560
US

V. Phone/Fax

Practice location:
  • Phone: 719-502-0740
  • Fax:
Mailing address:
  • Phone: 719-502-0740
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP00007155
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: