Provider Demographics
NPI:1164162897
Name:GOMEZ-QUEIRO, DILIA
Entity Type:Individual
Prefix:
First Name:DILIA
Middle Name:
Last Name:GOMEZ-QUEIRO
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:PO BOX 870218
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99687-0218
Mailing Address - Country:US
Mailing Address - Phone:510-303-2417
Mailing Address - Fax:
Practice Address - Street 1:1751 E GARDNER WAY STE F
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-6564
Practice Address - Country:US
Practice Address - Phone:907-214-1580
Practice Address - Fax:907-308-6744
Is Sole Proprietor?:No
Enumeration Date:2022-03-30
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst