Provider Demographics
NPI:1649735523
Name:GOMEZ, ROSA LINDA
Entity Type:Individual
Prefix:
First Name:ROSA
Middle Name:LINDA
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 1:142 TOMAHAWK DR
Mailing Address - Street 2:
Mailing Address - City:LACY LAKEVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:76705-3906
Mailing Address - Country:US
Mailing Address - Phone:254-495-6698
Mailing Address - Fax:
Practice Address - Street 1:142 TOMAHAWK DR
Practice Address - Street 2:
Practice Address - City:LACY LAKEVIEW
Practice Address - State:TX
Practice Address - Zip Code:76705-3906
Practice Address - Country:US
Practice Address - Phone:254-495-6698
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-05
Last Update Date:2019-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX880582163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse