Provider Demographics
NPI:1144962853
Name:GOMEZ, JULIANA O
Entity type:Individual
Prefix:MRS
First Name:JULIANA
Middle Name:O
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 1:212 E ROWLAND ST UNIT 197
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91723-3146
Mailing Address - Country:US
Mailing Address - Phone:626-426-4304
Mailing Address - Fax:626-364-7481
Practice Address - Street 1:914 W GROVECENTER ST # 91722
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91722-4123
Practice Address - Country:US
Practice Address - Phone:626-426-4304
Practice Address - Fax:626-364-7481
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-12
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172A00000XOther Service ProvidersDriverGroup - Single Specialty