MEDICARE: ANNABELLA F GOMEZ NIC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171R00000X	Interpreter	AG03071447	AZ

General Provider Information

NPI Number	:	1083501829
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNABELLA F GOMEZ NIC

Provider Business Mailing Address
First Line	:	38322 N 20TH ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85086-8816
Country	:	US
Telephone Number	:	480-406-0556
Fax Number	:

Provider Business Practice Location Address
First Line	:	38322 N 20TH ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85086-8816
Country	:	US
Telephone Number	:	480-406-0556
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/23/2025
Last Update Date	:	06/23/2025

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