Healthcare Provider Details

I. General information

NPI: 1154884062
Provider Name (Legal Business Name): YEZABEL MARIA COLON GOMEZ DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARIA YEZABEL COLON GOMEZ

II. Dates (important events)

Enumeration Date: 04/08/2019
Last Update Date: 05/15/2023
Certification Date: 05/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BAYLOR PLZ
HOUSTON TX
77030-3411
US

IV. Provider business mailing address

1 BAYLOR PLZ
HOUSTON TX
77030-3411
US

V. Phone/Fax

Practice location:
  • Phone: 832-822-2778
  • Fax:
Mailing address:
  • Phone: 832-822-2778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberOS18763
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberU06656
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number136756
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: