Provider Demographics
NPI:1083488936
Name:GOMEZ, LORETTA CERDA
Entity Type:Individual
Prefix:
First Name:LORETTA
Middle Name:CERDA
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22919 WHITE POWDER DR
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77373-2343
Mailing Address - Country:US
Mailing Address - Phone:361-946-6289
Mailing Address - Fax:
Practice Address - Street 1:22919 WHITE POWDER DR
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77373-2343
Practice Address - Country:US
Practice Address - Phone:361-946-6289
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-10
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111480043747A0650X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider