Provider Demographics
NPI:1689323644
Name:GOMEZ, BRENDA (LMT, LVN)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:LMT, LVN
Other - Prefix:
Other - First Name:BRENDA
Other - Middle Name:
Other - Last Name:GOMEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT, LVN
Mailing Address - Street 1:20201 GREAT EGRET LN
Mailing Address - Street 2:
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660-1928
Mailing Address - Country:US
Mailing Address - Phone:310-795-4965
Mailing Address - Fax:
Practice Address - Street 1:305 N HEATHERWILDE BLVD STE 140
Practice Address - Street 2:
Practice Address - City:PFLUGERVILLE
Practice Address - State:TX
Practice Address - Zip Code:78660-4190
Practice Address - Country:US
Practice Address - Phone:310-795-4965
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-18
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT136395225700000X
TX337513164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No164X00000XNursing Service ProvidersLicensed Vocational Nurse