Provider Demographics
NPI:1730553009
Name:GOMEZ, ANGEL EMMANUEL (LSA)
Entity type:Individual
Prefix:
First Name:ANGEL
Middle Name:EMMANUEL
Last Name:GOMEZ
Suffix:
Gender:
Credentials:LSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2539 CHESTNUT BND
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-4664
Mailing Address - Country:US
Mailing Address - Phone:956-334-6026
Mailing Address - Fax:956-334-6026
Practice Address - Street 1:9522 HUEBNER RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-1548
Practice Address - Country:US
Practice Address - Phone:956-334-6026
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-24
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXSA00989246ZC0007X
246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant