MEDICARE: ITCHEL AILEEN 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	163W00000X	Registered Nurse	14198557-3102	UT

General Provider Information

NPI Number	:	1194669671
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ITCHEL AILEEN GOMEZ

Provider Business Mailing Address
First Line	:	114 E 12450 S STE 204
Second Line	:
City	:	DRAPER
State	:	UT
Zip	:	84020-8060
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	114 E 12450 S STE 204
Second Line	:
City	:	DRAPER
State	:	UT
Zip	:	84020-8060
Country	:	US
Telephone Number	:	385-434-0300
Fax Number	:

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

Provider Enumeration Date	:	04/16/2026
Last Update Date	:	04/16/2026

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Directions to “ ITCHEL AILEEN GOMEZ ” Practice Location

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