Provider Demographics
NPI:1902374424
Name:GOMEZ, XOCHITL (LMT)
Entity Type:Individual
Prefix:
First Name:XOCHITL
Middle Name:
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5126 N LOOP 1604 E APT 3205
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78247-5956
Mailing Address - Country:US
Mailing Address - Phone:210-605-4604
Mailing Address - Fax:
Practice Address - Street 1:21320 WATER WOOD DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78266-2784
Practice Address - Country:US
Practice Address - Phone:210-605-4604
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-02
Last Update Date:2018-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXLMT113339225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist