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General NPI Number Information
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NPI Number | 1801322755
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Entity Type | Individual
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Provider Name | JUAN GABRIEL GOMEZ PMHNP
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Gender | Male
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Dates
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Enumeration Date | 05/11/2017
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Last Update Date | 08/08/2022
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Provider Practice Location Address
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Address Line | 5701 W TALAVI BLVD STE 180
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City | GLENDALE
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State | AZ
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Zip | 85306-1888
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Country | US
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Telephone | 480-335-8010
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Fax |
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Provider Business Mailing Address
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Address Line | 9219 W LOUISE DR
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City | PEORIA
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State | AZ
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Zip | 85383-3542
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Country | US
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Telephone | 480-335-8010
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | AP10242
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License Number State | AZ
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