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General NPI Number Information
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NPI Number | 1306027412
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Entity Type | Organization
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Legal Business Name | ROSE GOMEZ, M.D.,P.C.
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Dates
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Enumeration Date | 11/16/2007
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Last Update Date | 03/27/2008
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Provider Practice Location Address
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Address Line | 7600 W COLLEGE DR
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City | PALOS HEIGHTS
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State | IL
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Zip | 60463-1256
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Country | US
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Telephone | 708-361-1616
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Fax | 708-361-1502
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Provider Business Mailing Address
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Address Line | 875 N MICHIGAN AVE SUITE 3710
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City | CHICAGO
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State | IL
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Zip | 60611-1803
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Country | US
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Telephone | 312-951-2826
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ROSE GOMEZ
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Credential | M.D.,P.C.
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Telephone | 708-361-1616
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number | 36056870
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License Number State | IL
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