MEDICARE: MS. KATHRYN GOMEZ MSW

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	1041C0700X	Clinical Social Worker	22672	CA

General Provider Information

NPI Number	:	1922293604
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KATHRYN GOMEZ MSW

Provider Business Mailing Address
First Line	:	354 W HUNTSMAN AVE
Second Line	:
City	:	REEDLEY
State	:	CA
Zip	:	93654-3969
Country	:	US
Telephone Number	:	559-638-3063
Fax Number	:

Provider Business Practice Location Address
First Line	:	83 E SHAW AVE
Second Line	:	SUITE #102
City	:	FRESNO
State	:	CA
Zip	:	93710-7620
Country	:	US
Telephone Number	:	559-226-0167
Fax Number	:	559-226-1559

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

Provider Enumeration Date	:	09/06/2007
Last Update Date	:	02/24/2010

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