Healthcare Provider Details

I. General information

NPI: 1013325059
Provider Name (Legal Business Name): STEPHANIE MONIQUE GOMEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2014
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1627 S HARGRAVE ST
BANNING CA
92220-6169
US

IV. Provider business mailing address

1627 S HARGRAVE ST
BANNING CA
92220-6169
US

V. Phone/Fax

Practice location:
  • Phone: 951-922-7435
  • Fax:
Mailing address:
  • Phone: 951-922-7435
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: