Healthcare Provider Details

I. General information

NPI: 1528298361
Provider Name (Legal Business Name): GOMEZ & ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2009
Last Update Date: 08/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1630 HEATHER LN
REDLANDS CA
92373-5645
US

IV. Provider business mailing address

1630 HEATHER LN
REDLANDS CA
92373-5645
US

V. Phone/Fax

Practice location:
  • Phone: 909-792-9674
  • Fax:
Mailing address:
  • Phone: 909-792-9674
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171R00000X
TaxonomyInterpreter
License Number21966079
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code347E00000X
TaxonomyTransportation Broker
License Number
License Number State

VIII. Authorized Official

Name: MRS. MARY FRANCES GOMEZ
Title or Position: PRESIDENT
Credential:
Phone: 909-792-9674