Healthcare Provider Details

I. General information

NPI: 1477032167
Provider Name (Legal Business Name): ANN LIZA GOMEZ RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2018
Last Update Date: 08/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5313 N MCCOLL RD
MCALLEN TX
78504-2204
US

IV. Provider business mailing address

4208 KENNEDY ST
MERCEDES TX
78570-7414
US

V. Phone/Fax

Practice location:
  • Phone: 956-972-1920
  • Fax: 956-972-0339
Mailing address:
  • Phone: 956-472-5857
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number786450
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: