Individual
DESTINI RAE GOMEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1264 RODEO RD, SANTA FE, NM 87505-6816
(505) 982-2129
Mailing address
1264 RODEO RD, SANTA FE, NM 87505-6816
(505) 982-2129
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
60815
NM
207Q00000X
Family Medicine Physician
60815
NM
207R00000X
Internal Medicine Physician
60815
NM
208D00000X
General Practice Physician
60815
NM
363L00000X
Nurse Practitioner
Primary
60815
NM
Other
Enumeration date
04/12/2022
Last updated
03/05/2025
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