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General NPI Number Information
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NPI Number | 1659790756
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Entity Type | Individual
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Provider Name | MICHELE S GOMEZ-LEFFALL GRN
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Gender | Female
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Dates
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Enumeration Date | 04/16/2014
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Last Update Date | 03/30/2021
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Provider Practice Location Address
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Address Line | 402 W WHEATLAND RD STE 180
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City | DUNCANVILLE
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State | TX
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Zip | 75116-4600
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Country | US
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Telephone | 469-254-5346
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Fax | 682-759-5955
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Provider Business Mailing Address
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Address Line | 402 W WHEATLAND RD STE 180
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City | DUNCANVILLE
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State | TX
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Zip | 75116-4600
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Country | US
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Telephone | 469-254-5346
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Fax | 682-759-5955
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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 | 3747A0650X
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Taxonomy Name | Attendant Care Provider
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 164X00000X
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Taxonomy Name | Licensed Vocational Nurse
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License Number | 308029
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 174H00000X
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Taxonomy Name | Health Educator
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QP0905X
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Taxonomy Name | State or Local Public Health Clinic/Center
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License Number |
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License Number State |
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