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Provider Information for 1912501339

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 GOMEZ

Gender: FEMALE

Individual NPI: 1912501339

Calendar   Last Updated:  2020-11-25
  Certification Date:  2020-11-25

Details

Name Value
NPI 1912501339
Enumeration Date 2020-11-25
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address 171 INDEPENDENCE HILLS VLG
MORGANTOWN, WV 26505-2546
United States

Phone: 304-276-5076 | Fax: 304-471-2488
View Map External Link
Primary Practice Address 503 MORGANTOWN AVE
FAIRMONT, WV 26554-4388
United States

Phone: 304-363-7375 | Fax: 304-363-7376
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other URL agomez868686@gmail.com EMAIL Health Information Exchange (HIE) CSV 503 MORGANTOWN AVE
FAIRMONT, WV 26554-4388
United States
Other Identifiers
Issuer State Number
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 376J00000X - Homemaker