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General NPI Number Information
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NPI Number | 1336854504
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Entity Type | Individual
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Provider Name | JUSTIN ANTHONY GOMEZ FNP-C
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Gender | Male
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Dates
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Enumeration Date | 01/20/2023
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Last Update Date | 11/23/2025
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Provider Practice Location Address
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Address Line | 2902 TOM TENNANT DR
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City | WOODBURN
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State | OR
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Zip | 97071-2828
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Country | US
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Telephone | 971-345-4767
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Fax |
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Provider Business Mailing Address
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Address Line | 3187 E 3050 S
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City | SAINT GEORGE
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State | UT
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Zip | 84790-1372
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 10050797
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 863840
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License Number State | NV
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