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General NPI Number Information
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NPI Number | 1093428492
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Entity Type | Individual
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Provider Name | LAWRENCE EUGENE GOMES II DIRECT CARE WORKER
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Gender | Male
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Dates
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Enumeration Date | 12/30/2022
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Last Update Date | 12/12/2025
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Provider Practice Location Address
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Address Line | 10933 W COTTONWOOD LN
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City | AVONDALE
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State | AZ
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Zip | 85392-4322
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Country | US
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Telephone | 602-616-0723
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Fax |
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Provider Business Mailing Address
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Address Line | 10933 W COTTONWOOD LN
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City | AVONDALE
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State | AZ
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Zip | 85392-4322
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Country | US
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Telephone | 602-616-0723
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3747A0650X
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Taxonomy Name | Attendant Care Provider
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License Number | NA
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License Number State | AZ
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