Provider Demographics
NPI:1821961848
Name:GOMEZ, NICOLE JENIQUE
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:JENIQUE
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 1:959 GROFF ST
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91768-2341
Mailing Address - Country:US
Mailing Address - Phone:626-602-5976
Mailing Address - Fax:
Practice Address - Street 1:959 GROFF ST
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91768-2341
Practice Address - Country:US
Practice Address - Phone:626-602-5976
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-25
Last Update Date:2025-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula