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General NPI Number Information
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NPI Number | 1689569121
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Entity Type | Individual
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Provider Name | JENNICE GOMEZ OD
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Gender | Female
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Dates
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Enumeration Date | 06/12/2025
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Last Update Date | 06/12/2025
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Provider Practice Location Address
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Address Line | 6134 PACIFIC BLVD
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City | HUNTINGTON PARK
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State | CA
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Zip | 90255-2923
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Country | US
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Telephone | 323-589-3381
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Fax |
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Provider Business Mailing Address
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Address Line | 1144 W 149TH ST
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City | GARDENA
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State | CA
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Zip | 90247-3010
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Country | US
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Telephone | 310-918-6215
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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 | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPT35962TLG
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License Number State | CA
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