Provider Demographics
NPI:1790858587
Name:GOMEZ, EVELYN
Entity Type:Individual
Prefix:MISS
First Name:EVELYN
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 1:268 AVE MUNOZ RIVERA
Mailing Address - Street 2:SUITE M 3 WESTERNBANK WORLD PLAZA BLDG
Mailing Address - City:HATO REY
Mailing Address - State:PR
Mailing Address - Zip Code:00918-1913
Mailing Address - Country:US
Mailing Address - Phone:787-764-2228
Mailing Address - Fax:787-764-2228
Practice Address - Street 1:268 AVE MUNOZ RIVERA
Practice Address - Street 2:SUITE M 3 WESTERNBANK WORLD PLAZA BLDG
Practice Address - City:HATO REY
Practice Address - State:PR
Practice Address - Zip Code:00918-1913
Practice Address - Country:US
Practice Address - Phone:787-764-2228
Practice Address - Fax:787-764-2228
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR009979163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse