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Provider Information for 1396070934

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

MR. ALEJANDRO GOMEZ JR. MSW

Gender: MALE

Individual NPI: 1396070934

Calendar   Last Updated:  2009-10-15
  Certification Date: 

Details

Name Value
NPI 1396070934
Enumeration Date 2009-10-15
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address 1801 FOX DR
CHAMPAIGN, IL 61820-7236
United States

Phone: 217-639-4532 | Fax: 217-398-0172
View Map External Link
Primary Practice Address 1801 FOX DR
CHAMPAIGN, IL 61820-7236
United States

Phone: 217-639-4532 | Fax: 217-398-0172
View Map External Link
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 225C00000X - Rehabilitation Counselor