MEDICARE: MELISSA ELYSE GOMEZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician		CA

General Provider Information

NPI Number	:	1508724436
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA ELYSE GOMEZ

Provider Business Mailing Address
First Line	:	1200 CONCORD AVE STE 185
Second Line	:
City	:	CONCORD
State	:	CA
Zip	:	94520-5006
Country	:	US
Telephone Number	:	510-268-8120
Fax Number	:

Provider Business Practice Location Address
First Line	:	1843 C AVE
Second Line	:
City	:	NATIONAL CITY
State	:	CA
Zip	:	91950-5614
Country	:	US
Telephone Number	:	619-890-5160
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/12/2026
Last Update Date	:	01/12/2026

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