Provider Demographics
NPI:1780744938
Name:GOMEZ, LILLIAM I (MS)
Entity type:Individual
Prefix:MRS
First Name:LILLIAM
Middle Name:I
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:MS
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 817
Mailing Address - Street 2:
Mailing Address - City:ARROYO
Mailing Address - State:PR
Mailing Address - Zip Code:00714-0817
Mailing Address - Country:US
Mailing Address - Phone:787-839-5839
Mailing Address - Fax:787-839-5839
Practice Address - Street 1:AVE PEDRO ALBIZU CAMPUS
Practice Address - Street 2:HOSPITAL EPISCOPAL CRISTO REDENTO INSTITUTO DE AUDIO
Practice Address - City:GUYAMA
Practice Address - State:PR
Practice Address - Zip Code:00784
Practice Address - Country:US
Practice Address - Phone:787-864-0432
Practice Address - Fax:787-864-0432
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2018-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR446231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
64039Medicare UPIN