Provider Demographics
NPI:1891279907
Name:GOMEZ, DENISE M (NP)
Entity Type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:M
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MISS
Other - First Name:DENISE
Other - Middle Name:MARIE
Other - Last Name:DIAZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8782 W PEPPERTREE LN
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85305-3409
Mailing Address - Country:US
Mailing Address - Phone:347-325-2472
Mailing Address - Fax:
Practice Address - Street 1:7200 W BELL RD UNIT 101
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-8529
Practice Address - Country:US
Practice Address - Phone:602-795-8700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-24
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN182107207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine