Individual
TIFFANY MADISON ANGELICA GOMEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
6421 SQUIRREL NEST DR, LORAIN, OH 44053-4344
(440) 984-1354
Mailing address
3701 LEAVITT RD, LORAIN, OH 44053-2421
(440) 984-1354
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
50.007067RX
OH
Other
Enumeration date
02/05/2021
Last updated
09/29/2021
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