Provider Demographics
NPI:1790158798
Name:GOMEZ, NATALIA
Entity Type:Individual
Prefix:
First Name:NATALIA
Middle Name:
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 1:655 W IRVING PARK RD
Mailing Address - Street 2:UNIT 812
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-3123
Mailing Address - Country:US
Mailing Address - Phone:708-606-9628
Mailing Address - Fax:
Practice Address - Street 1:655 W IRVING PARK RD
Practice Address - Street 2:UNIT 812
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-3123
Practice Address - Country:US
Practice Address - Phone:708-606-9628
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-12
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist