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NPI Code Detail

MEDICARE: BECKY GOMEZ

MEDICARE: BECKY 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
1103K00000XBehavior Analyst1-25-84168IN
2106S00000XBehavior TechnicianRBT-22-213847IN

General Provider Information

NPI Number : 1770388035
Entity Type Code : Individual
Provider Name (Legal Business Name) : BECKY GOMEZ
Provider Business Mailing Address
First Line : 215 RED COACH DR
Second Line :
City : MISHAWAKA
State : IN
Zip : 46545-8307
Country : US
Telephone Number : 574-387-4313
Fax Number : 574-204-2868
Provider Business Practice Location Address
First Line : 511 W LINCOLN AVE
Second Line :
City : GOSHEN
State : IN
Zip : 46526-2430
Country : US
Telephone Number : 574-387-4313
Fax Number : 574-204-2868
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/19/2025
Last Update Date : 02/13/2026

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