Provider Demographics
NPI:1619173614
Name:GOMEZ DEL CARPIO, JIMENA MARIA (MD)
Entity type:Individual
Prefix:DR
First Name:JIMENA
Middle Name:MARIA
Last Name:GOMEZ DEL CARPIO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14841 179TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:WA
Mailing Address - Zip Code:98272-1127
Mailing Address - Country:US
Mailing Address - Phone:360-217-1155
Mailing Address - Fax:360-217-1154
Practice Address - Street 1:14841 179TH AVE SE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:WA
Practice Address - Zip Code:98272-1127
Practice Address - Country:US
Practice Address - Phone:360-217-1155
Practice Address - Fax:360-217-1154
Is Sole Proprietor?:No
Enumeration Date:2007-06-26
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD61325030207Q00000X
VA0101253599207Q00000X
MDD0066384207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMD61325030OtherWA STATE LICENSE NUMBER