MEDICARE: EDGAR GOMEZ DBAVILLA DORADA ADULT DAY CARE

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	251J00000X	Nursing Care Agency	119593	TX

General Provider Information

NPI Number	:	1922142884
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EDGAR GOMEZ DBAVILLA DORADA ADULT DAY CARE

Provider Business Mailing Address
First Line	:	1965 OLD PORT ISABEL RD
Second Line	:
City	:	BROWNSVILLE
State	:	TX
Zip	:	78521-2719
Country	:	US
Telephone Number	:	956-542-8950
Fax Number	:	956-542-8950

Provider Business Practice Location Address
First Line	:	1965 OLD PORT ISABEL RD
Second Line	:
City	:	BROWNSVILLE
State	:	TX
Zip	:	78521-2719
Country	:	US
Telephone Number	:	956-542-8950
Fax Number	:	956-542-8950

Authorized Official
Title or Position	:	OWNER DIRECTOR
Name	:	MR. EDGAR GOMEZ
Credential	:	B.B.A.
Telephone Number	:	956-542-8950

Provider Enumeration Date	:	02/16/2007
Last Update Date	:	08/22/2020

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