Individual
ANA L. GOMEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
3860 W OGDEN AVE, CHICAGO, IL 60623-2460
(773) 843-3000
(773) 843-2704
Mailing address
3860 W OGDEN AVE, CHICAGO, IL 60623-2460
(773) 843-3000
(773) 843-2704
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085003240
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
085003240
STATE LICENSE
IL
01
—
1078264
SPECIALTY BOARDS
IL
01
—
385002225
CS LICENSE
IL
Enumeration date
11/03/2008
Last updated
03/07/2023
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