Provider Demographics
NPI:1790268118
Name:GOMEZ, PERLY V
Entity Type:Individual
Prefix:
First Name:PERLY
Middle Name:V
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 1:59 CASA DEL FUEGO ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89012-5648
Mailing Address - Country:US
Mailing Address - Phone:702-301-6549
Mailing Address - Fax:
Practice Address - Street 1:59 CASA DEL FUEGO ST
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89012-5648
Practice Address - Country:US
Practice Address - Phone:702-301-6549
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-11
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health