MEDICARE: ALEX GOMEZ

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	163WC0200X	Critical Care Medicine Registered Nurse	781700	TX
2	363LA2100X	Acute Care Nurse Practitioner	AP129306	TX

General Provider Information

NPI Number	:	1134502438
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEX GOMEZ

Provider Business Mailing Address
First Line	:	3505 BRECKENRIDGE DR
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79936-1003
Country	:	US
Telephone Number	:	915-244-6643
Fax Number	:

Provider Business Practice Location Address
First Line	:	3505 BRECKENRIDGE DR
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79936-1003
Country	:	US
Telephone Number	:	915-244-6643
Fax Number	:

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

Provider Enumeration Date	:	07/04/2015
Last Update Date	:	05/21/2022

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Directions to “ ALEX GOMEZ ” Practice Location

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