MEDICARE: DANIELLE JANE 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	:	1821824863
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIELLE JANE GOMEZ

Provider Business Mailing Address
First Line	:	24701 RAYMOND WAY SPC 39
Second Line	:
City	:	LAKE FOREST
State	:	CA
Zip	:	92630-4726
Country	:	US
Telephone Number	:	949-434-7214
Fax Number	:

Provider Business Practice Location Address
First Line	:	24701 RAYMOND WAY SPC 39
Second Line	:
City	:	LAKE FOREST
State	:	CA
Zip	:	92630-4726
Country	:	US
Telephone Number	:	949-434-7214
Fax Number	:

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

Provider Enumeration Date	:	09/09/2024
Last Update Date	:	09/09/2024

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Directions to “ DANIELLE JANE GOMEZ ” Practice Location

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