Healthcare Provider Details

I. General information

NPI: 1225990096
Provider Name (Legal Business Name): CARMEN JOSEFINA ISABEL GOMEZ CORTEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2025
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1839 S EL DORADO ST
STOCKTON CA
95206-2025
US

IV. Provider business mailing address

1839 S EL DORADO ST
STOCKTON CA
95206-2025
US

V. Phone/Fax

Practice location:
  • Phone: 209-466-4200
  • Fax: 209-466-4446
Mailing address:
  • Phone: 209-466-4200
  • Fax: 209-466-4446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number101YA0400X
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: