Healthcare Provider Details

I. General information

NPI: 1568164663
Provider Name (Legal Business Name): MAYRA LORENA GOMEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2023
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16702 HOUSE HAHL RD
CYPRESS TX
77433-1902
US

IV. Provider business mailing address

16702 HOUSE HAHL RD
CYPRESS TX
77433-1902
US

V. Phone/Fax

Practice location:
  • Phone: 281-766-9669
  • Fax:
Mailing address:
  • Phone: 713-561-2454
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberW0588
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: