Provider Demographics
NPI:1861210031
Name:LUCIANO GOMEZ, GALAXY (HHA, PCA)
Entity type:Individual
Prefix:
First Name:GALAXY
Middle Name:
Last Name:LUCIANO GOMEZ
Suffix:
Gender:F
Credentials:HHA, PCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 94
Mailing Address - Street 2:
Mailing Address - City:TURTLE LAKE
Mailing Address - State:ND
Mailing Address - Zip Code:58575-0094
Mailing Address - Country:US
Mailing Address - Phone:406-396-8747
Mailing Address - Fax:
Practice Address - Street 1:301 EGGERT ST
Practice Address - Street 2:
Practice Address - City:TURTLE LAKE
Practice Address - State:ND
Practice Address - Zip Code:58575-4027
Practice Address - Country:US
Practice Address - Phone:406-396-8747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-27
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY510365251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health