Provider Demographics
NPI:1477032167
Name:GOMEZ, ANN LIZA (RN)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:LIZA
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4208 KENNEDY ST
Mailing Address - Street 2:
Mailing Address - City:MERCEDES
Mailing Address - State:TX
Mailing Address - Zip Code:78570-7414
Mailing Address - Country:US
Mailing Address - Phone:956-472-5857
Mailing Address - Fax:
Practice Address - Street 1:5313 N MCCOLL RD
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-2204
Practice Address - Country:US
Practice Address - Phone:956-972-1920
Practice Address - Fax:956-972-0339
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-13
Last Update Date:2018-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX786450163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse