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NPI Code Detail

MEDICARE: MR. ELISAMUEL RIVERA GOMEZ M.S., CCC-SLP

MEDICARE: MR. ELISAMUEL RIVERA GOMEZ M.S., CCC-SLP
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
1235Z00000XSpeech-Language PathologistSLP011025GA

General Provider Information

NPI Number : 1376165399
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. ELISAMUEL RIVERA GOMEZ M.S., CCC-SLP
Provider Business Mailing Address
First Line : 1875 CENTURY BLVD NE STE 200
Second Line :
City : ATLANTA
State : GA
Zip : 30345-3314
Country : US
Telephone Number : 404-633-8911
Fax Number :
Provider Business Practice Location Address
First Line : 1875 CENTURY BLVD NE STE 200
Second Line :
City : ATLANTA
State : GA
Zip : 30345-3314
Country : US
Telephone Number : 404-633-8911
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/13/2020
Last Update Date : 05/15/2022

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Directions to “ MR. ELISAMUEL RIVERA GOMEZ M.S., CCC-SLP” Practice Location

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