Healthcare Provider Details

I. General information

NPI: 1255262515
Provider Name (Legal Business Name): BECKY RENEE GOMEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 JUANA MARIA AVE
SANTA BARBARA CA
93103-2713
US

IV. Provider business mailing address

133 JUANA MARIA AVE
SANTA BARBARA CA
93103-2713
US

V. Phone/Fax

Practice location:
  • Phone: 208-597-1490
  • Fax:
Mailing address:
  • Phone: 208-597-1490
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number95382755
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: