Healthcare Provider Details

I. General information

NPI: 1033630058
Provider Name (Legal Business Name): MARIANGELA GOMEZ FERRER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2017
Last Update Date: 12/13/2023
Certification Date: 11/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 UNIVERSITY BLVD
GALVESTON TX
77555-5302
US

IV. Provider business mailing address

PO BOX 650859, DEPT. 710
DALLAS TX
75265-0859
US

V. Phone/Fax

Practice location:
  • Phone: 409-772-1011
  • Fax: 409-772-5683
Mailing address:
  • Phone: 409-772-1011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number2021013115
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number47909
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License Number47909
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: