Healthcare Provider Details

I. General information

NPI: 1649076860
Provider Name (Legal Business Name): TARA CHARMANE GOMEZ LM, CPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/19/2025
Last Update Date: 02/19/2025
Certification Date: 02/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3334 CESSNA DR
CAMERON PARK CA
95682-9133
US

IV. Provider business mailing address

3334 CESSNA DR
CAMERON PARK CA
95682-9133
US

V. Phone/Fax

Practice location:
  • Phone: 530-709-2000
  • Fax:
Mailing address:
  • Phone: 530-709-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number747
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: