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General NPI Number Information
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NPI Number | 1346936671
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Entity Type | Individual
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Provider Name | DORY LLAMADO GOMER
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Gender | Female
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Dates
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Enumeration Date | 04/11/2023
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Last Update Date | 04/22/2023
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Provider Practice Location Address
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Address Line | 1800 WESTERN AVE STE 103
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City | SAN BERNARDINO
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State | CA
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Zip | 92411-1352
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Country | US
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Telephone | 909-802-9374
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Fax |
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Provider Business Mailing Address
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Address Line | 11882 SANDRA CT
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City | LOMA LINDA
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State | CA
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Zip | 92354-6759
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Country | US
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Telephone | 909-802-4362
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 95022234
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 95022234
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 95022234
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License Number State | CA
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