Healthcare Provider Details

I. General information

NPI: 1275449860
Provider Name (Legal Business Name): HOLOCENE NURSING PRACTICE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2026
Last Update Date: 08/22/2026
Certification Date: 08/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18523 CAMINITO PASADERO UNIT 354
SAN DIEGO CA
92128-1071
US

IV. Provider business mailing address

18523 CAMINITO PASADERO UNIT 354
SAN DIEGO CA
92128-1071
US

V. Phone/Fax

Practice location:
  • Phone: 619-853-5578
  • Fax: 619-830-5132
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: CRYSTALOREN GOMEZ
Title or Position: PRESIDENT
Credential: FNP-BC, PMHNP-BC
Phone: 708-830-4575