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General NPI Number Information
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NPI Number | 1649509464
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Entity Type | Individual
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Provider Name | MR. ROBERTO GOMEZ
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Gender | Male
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Dates
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Enumeration Date | 12/08/2009
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Last Update Date | 12/08/2009
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Provider Practice Location Address
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Address Line | 1514 BANKER RD
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City | CANUTILLO
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State | TX
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Zip | 79835-8955
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Country | US
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Telephone | 915-256-2685
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Fax | 915-503-2138
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Provider Business Mailing Address
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Address Line | 1514 BANKER RD
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City | CANUTILLO
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State | TX
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Zip | 79835-8955
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Country | US
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Telephone | 915-256-2685
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Fax | 915-503-2138
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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 | 1041S0200X
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Taxonomy Name | School Social Worker
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License Number |
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License Number State |
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