Provider Demographics
NPI:1871215723
Name:GOMEZ, CHRISTOPHER LUIS (APRN)
Entity type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:LUIS
Last Name:GOMEZ
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:MR
Other - First Name:CHRISTOPHER
Other - Middle Name:LUIS
Other - Last Name:GOMEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN
Mailing Address - Street 1:401 N BERTRAND ST
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-4702
Mailing Address - Country:US
Mailing Address - Phone:928-380-1439
Mailing Address - Fax:
Practice Address - Street 1:77 W FOREST AVE STE 201
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-1483
Practice Address - Country:US
Practice Address - Phone:928-773-2222
Practice Address - Fax:928-773-2598
Is Sole Proprietor?:No
Enumeration Date:2022-09-16
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ280966363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily