MEDICARE: LIANNA RODELA-GOMEZ LMSW

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	20887	AZ

General Provider Information

NPI Number	:	1275382293
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LIANNA RODELA-GOMEZ LMSW

Provider Business Mailing Address
First Line	:	7493 N ORACLE RD STE 125
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85704-6328
Country	:	US
Telephone Number	:	520-556-2062
Fax Number	:

Provider Business Practice Location Address
First Line	:	7493 N ORACLE RD STE 125
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85704-6328
Country	:	US
Telephone Number	:	520-556-2062
Fax Number	:

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

Provider Enumeration Date	:	05/13/2024
Last Update Date	:	05/13/2024

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