Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0210X | Pediatric Nephrologist | 2018-00341 | NC |
NPI | 1104184464 |
---|---|
Provider Name | Liliana Michelle Gomez Mendez |
First Address | Charlotte, NC 28275-1069 |
Second Address | Greenville, NC 27834 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2012 |
Last Update Date | 10/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1104184464 | (05) | NC |
19W24 | BCBS OF NC (01) | NC |
NN19490322 | MEDICARE (01) | NC |