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Provider Information for 1316332299

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know

AMANDA RYAN GOMEZ

Gender: FEMALE

Individual NPI: 1316332299

Calendar   Last Updated:  2018-07-09
  Certification Date: 

Details

Name Value
NPI 1316332299
Enumeration Date 2015-03-30
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address 300 LONGWOOD AVE HUNNEWELL BUILDING, PAVILION 129, HOUSESTAFF LOUNGE
BOSTON, MA 02115-5724
United States

Phone: | Fax:
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Primary Practice Address 300 LONGWOOD AVE HUNNEWELL BUILDING, PAVILION 129, HOUSESTAFF LOUNGE
BOSTON, MA 02115
United States

Phone: 617-355-8241 | Fax:
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Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 208000000X - Pediatrics MA 274582