Healthcare Provider Details

I. General information

NPI: 1346188539
Provider Name (Legal Business Name): ELIS REGINA SANTOS MENDES GOMES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2026
Last Update Date: 03/23/2026
Certification Date: 03/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 MOORE ST
CENTRAL FALLS RI
02863-2533
US

IV. Provider business mailing address

45 MOORE ST
CENTRAL FALLS RI
02863-2533
US

V. Phone/Fax

Practice location:
  • Phone: 401-699-6338
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License NumberNA62692
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: