Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 057213 | NY |
NPI | 1043635071 |
---|---|
Provider Name | Tashorn Gomez |
First Address | Bronx, NY 10453-8202 |
Second Address | Bronx, NY 10453-8202 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/02/2014 |
Last Update Date | 18/05/2015 |