Healthcare Provider Details

I. General information

NPI: 1568163384
Provider Name (Legal Business Name): EMMA LEONA GOMEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EMMA LEONA GOMEZ

II. Dates (important events)

Enumeration Date: 03/17/2023
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

616 E HOBSONWAY
BLYTHE CA
92225-1739
US

IV. Provider business mailing address

774 JOSIE ST
BLYTHE CA
92225-1337
US

V. Phone/Fax

Practice location:
  • Phone: 760-698-3433
  • Fax:
Mailing address:
  • Phone: 760-698-3433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number84826
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: