Provider Demographics
NPI:1801162698
Name:GOMEZ, JOSE ANGEL (RRT)
Entity type:Individual
Prefix:MR
First Name:JOSE
Middle Name:ANGEL
Last Name:GOMEZ
Suffix:
Gender:M
Credentials:RRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1804 TAXCO DR
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78521-7701
Mailing Address - Country:US
Mailing Address - Phone:956-266-7894
Mailing Address - Fax:
Practice Address - Street 1:805 W PRICE RD
Practice Address - Street 2:STE. 6
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78520-8745
Practice Address - Country:US
Practice Address - Phone:956-546-1702
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-27
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX74502227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered