Healthcare Provider Details

I. General information

NPI: 1306554746
Provider Name (Legal Business Name): NATALIE NICOLE GOMEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2022
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5811 S SAN PEDRO ST
LOS ANGELES CA
90011-5323
US

IV. Provider business mailing address

5811 S SAN PEDRO ST
LOS ANGELES CA
90011-5323
US

V. Phone/Fax

Practice location:
  • Phone: 323-234-4445
  • Fax: 323-234-4477
Mailing address:
  • Phone: 323-234-4445
  • Fax: 323-234-4477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: