Healthcare Provider Details

I. General information

NPI: 1417114331
Provider Name (Legal Business Name): GLENDA GOMEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2008
Last Update Date: 07/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1885 LUNDY AVE
SAN JOSE CA
95131-1887
US

IV. Provider business mailing address

1885 LUNDY AVE
SAN JOSE CA
95131-1858
US

V. Phone/Fax

Practice location:
  • Phone: 408-460-5979
  • Fax: 408-284-9048
Mailing address:
  • Phone: 408-460-5979
  • Fax: 408-284-9048

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: