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General NPI Number Information
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NPI Number | 1902180466
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Entity Type | Organization
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Legal Business Name | M. GOMEZ INC.
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Dates
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Enumeration Date | 10/03/2011
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Last Update Date | 10/03/2011
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Provider Practice Location Address
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Address Line | 2266 N LINCOLN AVE LOWER LEVEL
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City | CHICAGO
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State | IL
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Zip | 60614-7600
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Country | US
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Telephone | 773-883-3953
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Fax | 773-883-3649
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Provider Business Mailing Address
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Address Line | 2266 N LINCOLN AVE LOWER LEVEL
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City | CHICAGO
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State | IL
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Zip | 60614-7600
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Country | US
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Telephone | 773-883-3953
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Fax | 773-883-3649
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Authorized Official
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Title or Position | PRESIDENT
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Name | MELJUN GOMEZ
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Credential | NP-C
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Telephone | 773-744-2935
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 209.008312
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License Number State | IL
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