Individual
MR. NICOLAS SHANE GOMEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NAVY DIVE IDC
Contact information
Practice address
2000 W MARINE VIEW DR, BLDG 2202 PSNS/IMF DIVE LOCKER - MEDICAL, EVERETT, WA 98207-0001
(425) 304-5504
Mailing address
2000 W MARINE VIEW DR, BLDG 2202 PSNS/IMF DIVE LOCKER - MEDICAL, EVERETT, WA 98207-0001
(425) 304-5504
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Enumeration date
05/16/2012
Last updated
05/16/2012
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