Healthcare Provider Details

I. General information

NPI: 1194382051
Provider Name (Legal Business Name): CLAUDIA PATINO GOMEZ RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2019
Last Update Date: 05/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2920 SONOMA BLVD
VALLEJO CA
94590-3875
US

IV. Provider business mailing address

PO BOX 22210
OAKLAND CA
94623-2210
US

V. Phone/Fax

Practice location:
  • Phone: 707-558-2000
  • Fax: 707-644-3507
Mailing address:
  • Phone: 510-535-4000
  • Fax: 510-535-4189

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number32320
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: