Provider Demographics
NPI:1770112302
Name:GOMEZ, DANIELLE (PA-C)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:9650 GROSS POINT RD STE 2900
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-5006
Mailing Address - Country:US
Mailing Address - Phone:847-570-1440
Mailing Address - Fax:847-570-1442
Practice Address - Street 1:9650 GROSS POINT RD STE 2900
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-5006
Practice Address - Country:US
Practice Address - Phone:847-570-1440
Practice Address - Fax:847-570-1442
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-06
Last Update Date:2020-10-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL085007880363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant