Provider Demographics
NPI:1144935750
Name:FERNANDO GOMEZ
Entity type:Organization
Organization Name:FERNANDO GOMEZ
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FERNANDO
Authorized Official - Middle Name:
Authorized Official - Last Name:GOMEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:805-256-1688
Mailing Address - Street 1:PO BOX 2669
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-0050
Mailing Address - Country:US
Mailing Address - Phone:469-353-2180
Mailing Address - Fax:
Practice Address - Street 1:4562 WESTINGHOUSE ST STE D
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-5797
Practice Address - Country:US
Practice Address - Phone:805-256-1688
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-18
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty