Gomez, Marissa Paulette

Gomez, Marissa Paulette is an individual health care provider with primary practice located at 12200 Montgomery Blvd Ne Apt D202 , Albuquerque NM 87111-4197. He recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Behavior Technician, Other Service Providers / Driver. Behavioral Health & Social Service Providers / Behavior Technician is his primary health care specialty. Gomez, Marissa Paulette can be contacted via phone (575) 288-8402.

Contact Information

Primary practice address
12200 Montgomery Blvd Ne Apt D202 Albuquerque NM 87111-4197
Phone: (575) 288-8402
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Behavior Technician 106S00000X
Other Service Providers / Driver 172A00000X 513575084 New Mexico

Profile Details

NPI number 1619432663
LBN Legal business name Gomez, Marissa Paulette
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 4th, 2019
Last updated Feb 27th, 2019 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1619432663 NPPES
New Mexico MEDICAID 3624309576

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