Jessica Gomez

 
 From: Stephanie Gonzales 
 Fax: 14654462460 
 To: 
 Fax: (446) 468-5465 
 Page: 2 of 20 
 03/15/2022 8:55 PM 
 POWERED BY 
 DaisyBill 
 From 
 Stephanie Gonzales 
 To 
 Subsequent Injuries Benefits Trust  
 Original Bill 
 Med Legal 
 patient 
 Jessica Gomez
 Billing Provider 
 MED-LEGAL 
 Claim Number 
 SIF46434658 
 dos 
 2019/17/06 
 Patient Control No. 
 1046db7466446-1 
 Charge Amount 
 $10,238.00
 DaisyBill.com 
 info@daisybill.com 
 (646) 846-7461 
 DaisyBill does not respond to incoming faxes. Please call or email.