Provider Demographics
NPI:1093002180
Name:GOMEZ, ROBERTO
Entity Type:Individual
Prefix:
First Name:ROBERTO
Middle Name:
Last Name:GOMEZ
Suffix:
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 1:441 E WHITTIER BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:LA HABRA
Mailing Address - State:CA
Mailing Address - Zip Code:90631-3982
Mailing Address - Country:US
Mailing Address - Phone:562-846-4842
Mailing Address - Fax:562-846-4829
Practice Address - Street 1:441 E WHITTIER BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:LA HABRA
Practice Address - State:CA
Practice Address - Zip Code:90631-3982
Practice Address - Country:US
Practice Address - Phone:562-846-4842
Practice Address - Fax:562-846-4829
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-08
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies