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General NPI Number Information
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NPI Number | 1366033391
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Entity Type | Individual
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Provider Name | JOSE JESUS GOMEZ ATC
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Gender | Male
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Dates
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Enumeration Date | 02/02/2021
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Last Update Date | 02/02/2021
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Provider Practice Location Address
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Address Line | 1500 N VERDUGO RD
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City | GLENDALE
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State | CA
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Zip | 91208-2809
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Country | US
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Telephone | 818-240-1000
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Fax | 818-291-6621
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Provider Business Mailing Address
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Address Line | 240 WEST VEDUGO AVE UNIT M
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City | BURBANK
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State | CA
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Zip | 91502
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Country | US
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Telephone | 818-559-1357
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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 | 174H00000X
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Taxonomy Name | Health Educator
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License Number |
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License Number State | CA
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