Provider Demographics
NPI:1982962338
Name:GOMEZ, RUDOLPHO (OTR/L)
Entity Type:Individual
Prefix:MR
First Name:RUDOLPHO
Middle Name:
Last Name:GOMEZ
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15821 N 165TH LN
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85388-1144
Mailing Address - Country:US
Mailing Address - Phone:602-510-8136
Mailing Address - Fax:
Practice Address - Street 1:15821 N 165TH LN
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85388-1144
Practice Address - Country:US
Practice Address - Phone:602-510-8136
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-23
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist