Healthcare Provider Details

I. General information

NPI: 1730545666
Provider Name (Legal Business Name): EVELYN GOMEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2016
Last Update Date: 03/22/2023
Certification Date: 03/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9801 DUBLIN BLVD
DUBLIN CA
94568-2835
US

IV. Provider business mailing address

305 BROOKSIDE DR
ANTIOCH CA
94509-6109
US

V. Phone/Fax

Practice location:
  • Phone: 925-829-9555
  • Fax:
Mailing address:
  • Phone: 510-307-9848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number32129
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberE2998161
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: