Provider Demographics
NPI:1780666743
Name:GOMEZ, ANNETTE (RNC)
Entity Type:Individual
Prefix:
First Name:ANNETTE
Middle Name:
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:RNC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:196 FOX RDG
Mailing Address - Street 2:
Mailing Address - City:CANYON LAKE
Mailing Address - State:TX
Mailing Address - Zip Code:78133-5408
Mailing Address - Country:US
Mailing Address - Phone:210-464-7753
Mailing Address - Fax:210-745-0562
Practice Address - Street 1:17323 IH 35 N STE 113
Practice Address - Street 2:
Practice Address - City:SCHERTZ
Practice Address - State:TX
Practice Address - Zip Code:78154-1278
Practice Address - Country:US
Practice Address - Phone:210-656-4878
Practice Address - Fax:210-745-0562
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2009-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX565954363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics