Healthcare Provider Details

I. General information

NPI: 1124541735
Provider Name (Legal Business Name): HOUSTON NOEL GOMEZ FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 E EXPRESSWAY 83
MISSION TX
78572
US

IV. Provider business mailing address

3302 BOCA CHICA BLVD
BROWNSVILLE TX
78521-5193
US

V. Phone/Fax

Practice location:
  • Phone: 956-585-7401
  • Fax: 956-550-9393
Mailing address:
  • Phone: 956-589-7171
  • Fax: 956-550-9393

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP134624
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: