Healthcare Provider Details

I. General information

NPI: 1710475520
Provider Name (Legal Business Name): NOEMI GOMEZ MS,BS , RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2018
Last Update Date: 12/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8801 FOLSOM BLVD STE 260
SACRAMENTO CA
95826-3250
US

IV. Provider business mailing address

2801 MANLOVE RD APT 27
SACRAMENTO CA
95826-3233
US

V. Phone/Fax

Practice location:
  • Phone: 916-382-4447
  • Fax:
Mailing address:
  • Phone: 831-236-5793
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-16-13403
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: