Provider Demographics
NPI:1043648066
Name:TRIGGS-GOMEZ, KHADIJAH
Entity Type:Individual
Prefix:
First Name:KHADIJAH
Middle Name:
Last Name:TRIGGS-GOMEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KHADIJAH
Other - Middle Name:
Other - Last Name:TRIGGS-GOMEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MASTERS DEGREE TSHH
Mailing Address - Street 1:2255 5TH AVE APT 6G
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10037-2014
Mailing Address - Country:US
Mailing Address - Phone:917-504-4202
Mailing Address - Fax:
Practice Address - Street 1:2255 5TH AVE APT 6G
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10037-2014
Practice Address - Country:US
Practice Address - Phone:917-504-4202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-30
Last Update Date:2013-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications