Healthcare Provider Details

I. General information

NPI: 1942794599
Provider Name (Legal Business Name): ERIK GOMEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2018
Last Update Date: 05/31/2023
Certification Date: 05/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6001 TELEGRAPH AVE
OAKLAND CA
94609-1310
US

IV. Provider business mailing address

1112 S BROADWAY
SANTA MARIA CA
93454-6608
US

V. Phone/Fax

Practice location:
  • Phone: 916-206-8853
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-23-63549
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: