Healthcare Provider Details

I. General information

NPI: 1922947761
Provider Name (Legal Business Name): TATIANA GOMEZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MRS. TATIANA GOMEZ-YEBOAH

II. Dates (important events)

Enumeration Date: 03/26/2026
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 E TACHEVAH DR
PALM SPRINGS CA
92262-5750
US

IV. Provider business mailing address

3902 DAMASK DR
CHARLOTTE NC
28206-2487
US

V. Phone/Fax

Practice location:
  • Phone: 760-424-7490
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: