Healthcare Provider Details

I. General information

NPI: 1851415806
Provider Name (Legal Business Name): CATIRIA G GOMEZ II
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

523 FOOTHILL BLVD
LA CANADA CA
91011-3507
US

IV. Provider business mailing address

117 E AVENUE 45
LOS ANGELES CA
90031-1308
US

V. Phone/Fax

Practice location:
  • Phone: 818-790-1802
  • Fax: 818-790-1332
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberTCH36171
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: