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General NPI Number Information
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NPI Number | 1073158051
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Entity Type | Individual
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Provider Name | JUAN GOMEZ JR.
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Gender | Male
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Dates
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Enumeration Date | 11/13/2019
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Last Update Date | 08/18/2021
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Provider Practice Location Address
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Address Line | 2008 N GAREY AVE
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City | POMONA
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State | CA
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Zip | 91767-2722
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Country | US
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Telephone | 909-623-6131
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Fax |
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Provider Business Mailing Address
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Address Line | 106 S. SEVENTH AVENUE
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City | LA PUENTE
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State | CA
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Zip | 91744
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Country | US
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Telephone | 626-961-8971
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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