Healthcare Provider Details

I. General information

NPI: 1235056110
Provider Name (Legal Business Name): ELIZABETH GOMEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

1119 E 215TH PL
CARSON CA
90745-1603
US

IV. Provider business mailing address

1119 E 215TH PL
CARSON CA
90745-1603
US

V. Phone/Fax

Practice location:
  • Phone: 213-568-7298
  • Fax:
Mailing address:
  • Phone: 213-568-7298
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number198320009
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: