Individual
MACKENZIE MARIE GOMEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
417 S 6TH ST, BOISE, ID 83702-7632
(208) 577-4460
(208) 577-4469
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
1200715
FL
363A00000X
Physician Assistant
Primary
4871647
ID
Other
Enumeration date
09/25/2023
Last updated
03/10/2025
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