| Doctor Name: | BLANCA GOMEZ |
| NPI Number: | 1164807780 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | AP128359 |
| Business Practice Address: | 3500 Carmen Ave Apt 1408 Rancho Viejo, TX - 785759577 |
| Business Phone Number: | 9562477000 |
| Business Fax Number: | 9563610854 |
| Mailing Address: | 3500 Carmen Ave Apt 1408, RANCHO VIEJO |
| State: | TX |
| Postal Code: | 785759577 |
| Phone Number: | 9562477000 |
| Fax Number: | 9563610854 |
| NPI Enumeration Date: | 07/24/2015 |
| NPI Last Update Date: | 07/24/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | AP128359 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |