Provider Demographics
NPI:1215396189
Name:GOMEZ, YESENIA (CNM)
Entity Type:Individual
Prefix:PROF
First Name:YESENIA
Middle Name:
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 VIA MIRADERO
Mailing Address - Street 2:SANJUANERA
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00727-3007
Mailing Address - Country:US
Mailing Address - Phone:787-703-4881
Mailing Address - Fax:
Practice Address - Street 1:75 VIA MIRADERO
Practice Address - Street 2:SANJUANERA
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00727-3007
Practice Address - Country:US
Practice Address - Phone:787-703-4881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-19
Last Update Date:2016-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1399367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife