# D GOMEZ PRACTICE LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1851134035
- **Authorized official:** DIANA M GOMEZ RN, MSN, PMHNP-BC (PSYCHIATRIC NURSE PRACTITIONER)
- **Authorized official phone:** (973) 919-5975

## Contact information

- **Practice address:** 100 E PALISADE AVE APT D42, ENGLEWOOD, NJ 07631-3072
- **Practice address phone:** (973) 919-5975
- **Practice address fax:** (973) 528-3204
- **Mailing address:** 100 E PALISADE AVE APT D42, ENGLEWOOD, NJ 07631-3072
- **Mailing address phone:** (973) 919-5975
- **Mailing address fax:** (973) 528-3204

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LF0000X | Family Nurse Practitioner | — | NULL | — |
| 363LF0000X | Family Nurse Practitioner | — | — | — |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | NULL | Yes |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 06/17/2024
- **Last updated:** 06/17/2024