Healthcare Provider Details

I. General information

NPI: 1073103016
Provider Name (Legal Business Name): VALERIE GOMEZ WHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2021
Last Update Date: 02/11/2022
Certification Date: 02/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19582 BEACH BLVD
HUNTINGTON BEACH CA
92648-5994
US

IV. Provider business mailing address

19582 BEACH BLVD STE 202
HUNTINGTON BEACH CA
92648-2996
US

V. Phone/Fax

Practice location:
  • Phone: 714-841-9899
  • Fax:
Mailing address:
  • Phone: 714-841-9899
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number95016043
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: