MEDICARE: ALEXANDRA GOMEZ NP

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	363LA2200X	Adult Health Nurse Practitioner	309898	NY

General Provider Information

NPI Number	:	1205449113
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXANDRA GOMEZ NP

Provider Business Mailing Address
First Line	:	2233 ESPLANADE AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10469-5405
Country	:	US
Telephone Number	:	718-918-1100
Fax Number	:	718-918-1106

Provider Business Practice Location Address
First Line	:	2233 ESPLANADE AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10469-5405
Country	:	US
Telephone Number	:	718-918-1100
Fax Number	:	718-918-1106

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

Provider Enumeration Date	:	08/29/2020
Last Update Date	:	01/05/2021

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