Provider Demographics
NPI:1518540384
Name:GOMEZ, XENIA
Entity Type:Individual
Prefix:MS
First Name:XENIA
Middle Name:
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 1:3990 75TH ST W APT 120
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34209-5800
Mailing Address - Country:US
Mailing Address - Phone:941-226-5342
Mailing Address - Fax:
Practice Address - Street 1:3990 75TH ST W APT 120
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34209-5800
Practice Address - Country:US
Practice Address - Phone:941-226-5342
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-29
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care