Provider Demographics
NPI:1235394370
Name:GOMEZ, JUAN JOSE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:JOSE
Last Name:GOMEZ
Suffix:
Gender:M
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3013 FIR AVE
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78501-8024
Mailing Address - Country:US
Mailing Address - Phone:956-878-3474
Mailing Address - Fax:956-630-9449
Practice Address - Street 1:3013 FIR AVE
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501-8024
Practice Address - Country:US
Practice Address - Phone:956-878-3474
Practice Address - Fax:956-630-9449
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-28
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24906235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist