Individual
EVA H GOMEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
9401 W GARFIELD ST, TOLLESON, AZ 85353-1606
(623) 533-3969
(623) 936-0649
Mailing address
9401 W GARFIELD ST, TOLLESON, AZ 85353-1606
(623) 533-3969
(623) 936-0649
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LP049214
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
741589
AHCCCS
—
Enumeration date
09/13/2021
Last updated
09/13/2021
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