Provider Demographics
NPI:1972519940
Name:GOMEZ, ANITA PAIZ (MD)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:PAIZ
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 6880
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87502-6880
Mailing Address - Country:US
Mailing Address - Phone:505-955-5945
Mailing Address - Fax:505-982-6298
Practice Address - Street 1:901 W ALAMEDA ST
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87501-1681
Practice Address - Country:US
Practice Address - Phone:505-955-9454
Practice Address - Fax:505-982-6298
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NM79-303207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM5496Medicaid