MEDICARE: GLORIA GOMEZ

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	101Y00000X	Counselor

General Provider Information

NPI Number	:	1427420322
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GLORIA GOMEZ

Provider Business Mailing Address
First Line	:	2031 DUGDALE RD
Second Line	:
City	:	NORTH CHICAGO
State	:	IL
Zip	:	60064-1928
Country	:	US
Telephone Number	:	847-785-8660
Fax Number	:	847-785-8665

Provider Business Practice Location Address
First Line	:	2031 DUGDALE RD
Second Line	:
City	:	NORTH CHICAGO
State	:	IL
Zip	:	60064-1928
Country	:	US
Telephone Number	:	847-785-8660
Fax Number	:	847-785-8665

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

Provider Enumeration Date	:	10/30/2015
Last Update Date	:	10/30/2015

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Directions to “ GLORIA GOMEZ ” Practice Location

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