Provider Demographics
NPI:1780166512
Name:GOMEZ, MARIANA
Entity type:Individual
Prefix:
First Name:MARIANA
Middle Name:
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 E REDBUD AVE STE 5A-5B
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-2644
Mailing Address - Country:US
Mailing Address - Phone:956-353-9508
Mailing Address - Fax:866-610-1692
Practice Address - Street 1:901 E REDBUD AVE STE 5A-5B
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-2644
Practice Address - Country:US
Practice Address - Phone:956-353-9508
Practice Address - Fax:866-610-1692
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-29
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX388952355S0801X
1-22-62991103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant