Provider Demographics
NPI:1083503494
Name:GOMEZ, SAMANTHA N
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:N
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3877 12TH ST
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92501-3578
Mailing Address - Country:US
Mailing Address - Phone:951-642-5044
Mailing Address - Fax:
Practice Address - Street 1:6840 37TH ST
Practice Address - Street 2:
Practice Address - City:JURUPA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92509-1315
Practice Address - Country:US
Practice Address - Phone:951-826-1924
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-01
Last Update Date:2025-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician