Healthcare Provider Details

I. General information

NPI: 1720201627
Provider Name (Legal Business Name): MR. CESAR AUGUSTO GOMEZ JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 05/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

867 N FAIR OAKS AVE
PASADENA CA
91103-3083
US

IV. Provider business mailing address

867 N FAIR OAKS AVE
PASADENA CA
91103-3083
US

V. Phone/Fax

Practice location:
  • Phone: 626-246-1725
  • Fax:
Mailing address:
  • Phone: 626-246-1725
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number24166
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: