MEDICARE: MR. STEVEN GOMEZ HERRERA SR. LPO, BOCPO

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	222Z00000X	Orthotist	1142	TX
2	224P00000X	Prosthetist	1142	TX

General Provider Information

NPI Number	:	1326692351
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. STEVEN GOMEZ HERRERA SR. LPO, BOCPO

Provider Business Mailing Address
First Line	:	7410 JOHN SMITH DR STE 213
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-6000
Country	:	US
Telephone Number	:	210-481-4473
Fax Number	:	210-481-4479

Provider Business Practice Location Address
First Line	:	7410 JOHN SMITH DR STE 213
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-6000
Country	:	US
Telephone Number	:	210-481-4473
Fax Number	:	210-481-4479

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

Provider Enumeration Date	:	07/29/2019
Last Update Date	:	05/25/2021

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