Provider Demographics
NPI:1790127306
Name:GOMEZ-RAMOS, PRISCILLA (PA-C)
Entity Type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:
Last Name:GOMEZ-RAMOS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:PRISCILLA
Other - Middle Name:
Other - Last Name:RAMOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:4502 MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-4402
Mailing Address - Country:US
Mailing Address - Phone:210-743-2900
Mailing Address - Fax:210-358-8451
Practice Address - Street 1:4502 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-4402
Practice Address - Country:US
Practice Address - Phone:210-743-2900
Practice Address - Fax:210-358-8451
Is Sole Proprietor?:No
Enumeration Date:2013-07-24
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA08614363A00000X
363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX323461903Medicaid
TX323461904OtherCSHCN
TX565776YK00Medicare UPIN
308868YNNNMedicare PIN