Individual
MICHAEL RAY GOMEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3400 W 16TH ST STE P, GREELEY, CO 80634-6871
(970) 978-4386
Mailing address
3400 W 16TH ST STE P, GREELEY, CO 80634-6871
(970) 978-4386
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
PN0335320
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NONE
NONE
—
Enumeration date
08/17/2021
Last updated
08/17/2021
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