MEDICARE: DAISY GOMEZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	373H00000X	Day Training/Habilitation Specialist

General Provider Information

NPI Number	:	1063819415
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAISY GOMEZ

Provider Business Mailing Address
First Line	:	1499 HUNTINGTON DR STE 100
Second Line	:
City	:	SOUTH PASADENA
State	:	CA
Zip	:	91030-5443
Country	:	US
Telephone Number	:	626-403-4370
Fax Number	:

Provider Business Practice Location Address
First Line	:	1499 HUNTINGTON DR STE 100
Second Line	:
City	:	SOUTH PASADENA
State	:	CA
Zip	:	91030-5443
Country	:	US
Telephone Number	:	626-403-4370
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/01/2014
Last Update Date	:	10/07/2025

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Directions to “ DAISY GOMEZ ” Practice Location

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