Healthcare Provider Details

I. General information

NPI: 1932539152
Provider Name (Legal Business Name): GEORGINA F. GOMEZ-LIEBERMAN CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2013
Last Update Date: 11/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2025 GALISTEO ST
SANTA FE NM
87505-2101
US

IV. Provider business mailing address

2025 GALISTEO ST
SANTA FE NM
87505-2101
US

V. Phone/Fax

Practice location:
  • Phone: 505-913-4901
  • Fax: 505-913-6426
Mailing address:
  • Phone: 505-913-4901
  • Fax: 505-913-6426

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberCNP-02290
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: