Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207K00000X | Allergist & Immunologist | AP126745 | TX |
Y | 363L00000X | Nurse Practitioner | AP126745 | TX |
NPI | 1063817849 |
---|---|
Provider Name | Erica Elizabeth Gomez |
First Address | San Antonio, TX 78229-4870 |
Second Address | San Antonio, TX 78224-1361 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/10/2014 |
Last Update Date | 29/04/2020 |