Healthcare Provider Details

I. General information

NPI: 1689693699
Provider Name (Legal Business Name): DANIEL ROY GOMES D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 02/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 MOWRY AVE
FREMONT CA
94538-1712
US

IV. Provider business mailing address

15 HIDDEN OAK CT
DANVILLE CA
94506-2022
US

V. Phone/Fax

Practice location:
  • Phone: 510-794-6699
  • Fax: 510-794-6637
Mailing address:
  • Phone: 925-484-1395
  • Fax: 925-924-0969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberE1728
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: