MEDICARE: DR. ROSA ELIA GOMEZ D.S.W.

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	101YM0800X	Mental Health Counselor	LCS 16600	CA
2	1041C0700X	Clinical Social Worker	LCS 16600	CA

General Provider Information

NPI Number	:	1932364098
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROSA ELIA GOMEZ D.S.W.

Provider Business Mailing Address
First Line	:	PO BOX 9104
Second Line	:
City	:	REDLANDS
State	:	CA
Zip	:	92375-2304
Country	:	US
Telephone Number	:	909-936-4599
Fax Number	:

Provider Business Practice Location Address
First Line	:	11801 PIERCE ST STE 200
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92505-4400
Country	:	US
Telephone Number	:	909-369-4599
Fax Number	:

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

Provider Enumeration Date	:	07/28/2008
Last Update Date	:	01/07/2019

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