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General NPI Number Information
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NPI Number | 1841709797
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Entity Type | Individual
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Provider Name | DIANA GOMEZ
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Gender | Female
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Dates
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Enumeration Date | 09/22/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 45-25 48 STREET APT 3C
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City | WOODSIDE
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State | NY
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Zip | 11377
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Country | US
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Telephone | 646-894-1157
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Fax |
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Provider Business Mailing Address
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Address Line | 4525 48TH ST APT 3C
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City | WOODSIDE
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State | NY
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Zip | 11377-5311
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Country | US
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Telephone | 646-894-1157
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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 | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | 021922
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License Number State | NY
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