Provider Demographics
NPI:1265680581
Name:MORRIS, ELIZA GOMEZ
Entity Type:Individual
Prefix:
First Name:ELIZA
Middle Name:GOMEZ
Last Name:MORRIS
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 1:2924 SE BAMBOO ST
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34997-7806
Mailing Address - Country:US
Mailing Address - Phone:772-221-1631
Mailing Address - Fax:
Practice Address - Street 1:2924 SE BAMBOO ST
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34997-7806
Practice Address - Country:US
Practice Address - Phone:772-221-1631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-28
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator