Healthcare Provider Details

I. General information

NPI: 1487031555
Provider Name (Legal Business Name): JESSICA STEPHANIE GAMEZ RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2015
Last Update Date: 04/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81 OCEAN PKWY APT 3B
BROOKLYN NY
11218-1763
US

IV. Provider business mailing address

520 E 137TH ST APT 11I
BRONX NY
10454-4222
US

V. Phone/Fax

Practice location:
  • Phone: 917-975-4081
  • Fax:
Mailing address:
  • Phone: 718-585-0111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number698564
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: