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Provider Information for 1770131526

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

ALEJANDRO GOMEZ

Gender: MALE

Individual NPI: 1770131526

Calendar   Last Updated:  2019-08-26
  Certification Date: 

Details

Name Value
NPI 1770131526
Enumeration Date 2019-08-26
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address 7409 143RD STREET CT
APPLE VALLEY, MN 55124-8508
United States

Phone: | Fax:
View Map External Link
Primary Practice Address 7409 143RD STREET CT
APPLE VALLEY, MN 55124-8508
United States

Phone: 612-702-8244 | Fax:
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 390200000X - Student in an Organized Health Care Education/Training Program