Provider Demographics
NPI:1720724388
Name:GOMEZ, TEHNIYAH N (PNP-PC)
Entity Type:Individual
Prefix:
First Name:TEHNIYAH
Middle Name:N
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:PNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7580 SW DUNSMUIR LN
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97007-5963
Mailing Address - Country:US
Mailing Address - Phone:805-588-5843
Mailing Address - Fax:
Practice Address - Street 1:9135 SW BARNES RD STE 763
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-6777
Practice Address - Country:US
Practice Address - Phone:503-216-6560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-06
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR202205327NP-PP363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics