Provider Demographics
NPI:1629512751
Name:GOMEZ, CARA (EDD, ATC, CSCS)
Entity Type:Individual
Prefix:DR
First Name:CARA
Middle Name:
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:EDD, ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 395
Mailing Address - Street 2:211 HIGHLAND AVE
Mailing Address - City:CLAYTON
Mailing Address - State:DE
Mailing Address - Zip Code:19938
Mailing Address - Country:US
Mailing Address - Phone:305-975-4949
Mailing Address - Fax:
Practice Address - Street 1:211 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:DE
Practice Address - Zip Code:19938
Practice Address - Country:US
Practice Address - Phone:305-975-4949
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-08
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ3-00003012255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer