Individual
MRS. TARA A GOMEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN SFA
Contact information
Practice address
2300 E 30TH ST BLDG D STE 101, FARMINGTON, NM 87401-8990
(505) 327-1400
(505) 564-3202
Mailing address
2300 E 30TH ST BLDG D STE 101, FARMINGTON, NM 87401-8990
(505) 327-1400
(505) 564-3202
Taxonomy
Speciality
Code
Description
License number
State
163WX0800X
Orthopedic Registered Nurse
Primary
R52863
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00NM006H18
BCBS
NM
01
—
10034667
LOVELACE
NM
05
—
47522
—
NM
01
—
R52863
NEW MEXICO BOARD OF NURSI
NM
Enumeration date
08/23/2007
Last updated
05/06/2008
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