Healthcare Provider Details

I. General information

NPI: 1083488936
Provider Name (Legal Business Name): LORETTA CERDA GOMEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2023
Last Update Date: 11/10/2023
Certification Date: 11/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22919 WHITE POWDER DR
SPRING TX
77373-2343
US

IV. Provider business mailing address

22919 WHITE POWDER DR
SPRING TX
77373-2343
US

V. Phone/Fax

Practice location:
  • Phone: 361-946-6289
  • Fax:
Mailing address:
  • Phone: 361-946-6289
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number11148004
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: