Healthcare Provider Details

I. General information

NPI: 1477057743
Provider Name (Legal Business Name): YASMIN GOMEZ M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2018
Last Update Date: 03/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 E 10TH ST STE 1
TRACY CA
95376-4058
US

IV. Provider business mailing address

326 HARRIS AVE
RODEO CA
94572-1039
US

V. Phone/Fax

Practice location:
  • Phone: 510-782-0950
  • Fax:
Mailing address:
  • Phone: 510-734-9275
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: