Healthcare Provider Details

I. General information

NPI: 1518665595
Provider Name (Legal Business Name): GINA MICHELLE GOMEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: GINA MICHELLE HOERIG

II. Dates (important events)

Enumeration Date: 02/20/2023
Last Update Date: 02/20/2023
Certification Date: 02/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1235 E ST
FRESNO CA
93706-2024
US

IV. Provider business mailing address

2741 W MISSION CT
VISALIA CA
93277-7258
US

V. Phone/Fax

Practice location:
  • Phone: 559-268-6261
  • Fax:
Mailing address:
  • Phone: 559-545-9188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License Number582440
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: