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NPI Code Detail

MEDICARE: NICHOLAS RAYMOND GOMEZ

MEDICARE: NICHOLAS RAYMOND 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
1106S00000XBehavior TechnicianRBT-20-115416CA

General Provider Information

NPI Number : 1992201669
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICHOLAS RAYMOND GOMEZ
Provider Business Mailing Address
First Line : 4067 W 3RD ST APT 404
Second Line :
City : LOS ANGELES
State : CA
Zip : 90020-5900
Country : US
Telephone Number : 626-221-0477
Fax Number :
Provider Business Practice Location Address
First Line : 177 E COLORADO BLVD STE 2082
Second Line :
City : PASADENA
State : CA
Zip : 91105-1986
Country : US
Telephone Number : 844-669-7827
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/02/2018
Last Update Date : 07/12/2021

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Directions to “ NICHOLAS RAYMOND GOMEZ ” Practice Location

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