Provider Demographics
NPI:1255668992
Name:GOMEZ, CHRISTOPHER MANUEL I (BSHS)
Entity type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:MANUEL
Last Name:GOMEZ
Suffix:I
Gender:M
Credentials:BSHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 843
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:NM
Mailing Address - Zip Code:88048-0843
Mailing Address - Country:US
Mailing Address - Phone:575-496-6806
Mailing Address - Fax:
Practice Address - Street 1:1401 S DON ROSER DR STE D
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-4567
Practice Address - Country:US
Practice Address - Phone:575-522-5144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-17
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM171M00000X104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker