Provider Demographics
NPI:1134864804
Name:GOMEZ, AJA (DC)
Entity type:Individual
Prefix:
First Name:AJA
Middle Name:
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:AJA
Other - Middle Name:
Other - Last Name:RYAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:5659 MAUNA LOA BLVD UNIT 209
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34240-7086
Mailing Address - Country:US
Mailing Address - Phone:240-577-9871
Mailing Address - Fax:
Practice Address - Street 1:5659 MAUNA LOA BLVD UNIT 209
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34240-7086
Practice Address - Country:US
Practice Address - Phone:240-577-9871
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-28
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH13830111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor