MEDICARE: MR. CHRISTOPHER MANUEL GOMEZ I BSHS

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	104100000X	Social Worker	171M00000X	NM

General Provider Information

NPI Number	:	1255668992
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CHRISTOPHER MANUEL GOMEZ I BSHS

Provider Business Mailing Address
First Line	:	PO BOX 843
Second Line	:
City	:	MESQUITE
State	:	NM
Zip	:	88048-0843
Country	:	US
Telephone Number	:	575-496-6806
Fax Number	:

Provider Business Practice Location Address
First Line	:	1401 S DON ROSER DR STE D
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88011-4567
Country	:	US
Telephone Number	:	575-522-5144
Fax Number	:

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

Provider Enumeration Date	:	11/17/2009
Last Update Date	:	11/17/2009

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