Healthcare Provider Details

I. General information

NPI: 1255267167
Provider Name (Legal Business Name): EDITH DINORAH GOMEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 S 4TH AVE
YAKIMA WA
98902-3546
US

IV. Provider business mailing address

2209 W 22ND AVE
KENNEWICK WA
99337-2825
US

V. Phone/Fax

Practice location:
  • Phone: 509-575-4084
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: