Active NPI
Javier Gomez, RDN, CDE
- Registered Dietitian
- Tucson, AZ
National Provider Identifier
1720196801
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- DT06671
- Practice address
- 1100 E Ajo Way Ste 212
Tucson, AZ 85713 - Phone
- (520) 904-0889
- NPI assigned
- Aug 28, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | DT06671 | TX | Primary |
Addresses
Primary practice location
1100 E Ajo Way Ste 212
Tucson, AZ 85713
Mailing address
11414 E Squash Blossom Loop
Tucson, AZ 85747-6219
Phone (520) 904-0889
Other practice location 1
5001 N Piedras St
El Paso, TX 79930-4210
Phone (915) 564-7847
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in AZ
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20190705000581 | AZ | Practitioner - Registered Dietitian Or Nutrition Professional | 7012242555 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DT06671 | TX | MD | Registered Dietitian |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Fay Nutrition | Dietitian, Registered | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156723200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1548115200000",
"number": "1720196801",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11414 E SQUASH BLOSSOM LOOP",
"city": "TUCSON",
"state": "AZ",
"postal_code": "857476219",
"telephone_number": "520-904-0889"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1100 E AJO WAY STE 212",
"city": "TUCSON",
"state": "AZ",
"postal_code": "85713",
"telephone_number": "520-904-0889"
}
],
"practiceLocations": [
{
"address_1": "5001 N Piedras St",
"address_purpose": "LOCATION",
"city": "El Paso",
"state": "TX",
"postal_code": "799304210",
"country_code": "US",
"telephone_number": "915-564-7847",
"fax_number": "915-564-7579",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "GOMEZ",
"first_name": "JAVIER",
"credential": "RDN, CDE",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-08-28",
"last_updated": "2019-01-22",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "TX",
"license": "DT06671",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tucson, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.