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General NPI Number Information
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NPI Number | 1144028697
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Entity Type | Individual
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Provider Name | LAUREN GOMEZ
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Gender | Female
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Dates
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Enumeration Date | 03/03/2025
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Last Update Date | 03/03/2025
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Provider Practice Location Address
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Address Line | 2612 S WALTON BLVD STE 10
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City | BENTONVILLE
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State | AR
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Zip | 72712-7558
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Country | US
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Telephone | 479-395-1115
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Fax |
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Provider Business Mailing Address
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Address Line | 6304 SW GNEISS AVE UNIT 1
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City | BENTONVILLE
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State | AR
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Zip | 72713-5208
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Country | US
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Telephone | 210-322-7934
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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 | 246Z00000X
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Taxonomy Name | Other Specialist/Technologist
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License Number | 8105
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License Number State | AR
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