Provider Demographics
NPI:1043559289
Name:GOMEZ, SETH K SR
Entity Type:Individual
Prefix:MR
First Name:SETH
Middle Name:K
Last Name:GOMEZ
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40849 FREMONT BLVD
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-4306
Mailing Address - Country:US
Mailing Address - Phone:510-358-5865
Mailing Address - Fax:510-580-4591
Practice Address - Street 1:40849 FREMONT BLVD
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-4306
Practice Address - Country:US
Practice Address - Phone:510-358-5865
Practice Address - Fax:510-580-4591
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-07
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker