Individual
JUDITH GOMEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LAC
Contact information
Practice address
815 E CESAR CHAVEZ BLVD, SAN LUIS, AZ 85349
(928) 627-3822
(928) 627-6666
Mailing address
PO BOX 2017, SAN LUIS, AZ 85349-2017
(928) 627-3822
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
LAC-16498
AZ
Other
Enumeration date
08/06/2019
Last updated
08/06/2019
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