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Individual
LAUREN ELIZABETH DEMO GOMEZ
Active
Individual
LAUREN ELIZABETH DEMO GOMEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0010-12087
NC
363A00000X
Physician Assistant
4291
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5003PA
—
SC
Enumeration date
12/17/2021
Last updated
08/09/2024
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