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General NPI Number Information
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NPI Number | 1124863253
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Entity Type | Individual
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Provider Name | LIANNI YAQUELIN GOMEZ SA - C
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Gender | Female
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Dates
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Enumeration Date | 06/29/2024
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Last Update Date | 04/16/2025
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Provider Practice Location Address
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Address Line | 10240 SPRING HILL DR
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City | SPRING HILL
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State | FL
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Zip | 34608-6677
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Country | US
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Telephone | 352-701-7768
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Fax |
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Provider Business Mailing Address
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Address Line | 10240 SPRING HILL DR
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City | SPRING HILL
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State | FL
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Zip | 34608-6677
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Country | US
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Telephone |
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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 | 246ZC0007X
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Taxonomy Name | Surgical Assistant
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License Number | 24-318
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT-25-427763
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License Number State | FL
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