Provider Demographics
NPI:1790508224
Name:GOMEZ, ANNA R (RD, LD, CBS)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:R
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:RD, LD, CBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9405 N OAK TRFY
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64155-2233
Mailing Address - Country:US
Mailing Address - Phone:816-412-2900
Mailing Address - Fax:
Practice Address - Street 1:9405 N OAK TRFY
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64155-2233
Practice Address - Country:US
Practice Address - Phone:816-412-2900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-04
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2024022124133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered