MEDICARE: ADAN 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	171WH0202X	Home Modifications Contractor	19137000	TX

General Provider Information

NPI Number	:	1528502176
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADAN GOMEZ

Provider Business Mailing Address
First Line	:	5309 MOUNTAIN VIEW LN E
Second Line	:
City	:	EDINBURG
State	:	TX
Zip	:	78542-0257
Country	:	US
Telephone Number	:	956-566-2931
Fax Number	:

Provider Business Practice Location Address
First Line	:	5309 MOUNTAIN VIEW LN E
Second Line	:
City	:	EDINBURG
State	:	TX
Zip	:	78542-0257
Country	:	US
Telephone Number	:	956-566-2931
Fax Number	:

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

Provider Enumeration Date	:	12/15/2016
Last Update Date	:	12/15/2016

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Directions to “ ADAN GOMEZ ” Practice Location

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