Provider Demographics
NPI:1184032872
Name:EUNICE MARIE ALVARE GOMEZ
Entity Type:Organization
Organization Name:EUNICE MARIE ALVARE GOMEZ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN
Authorized Official - Prefix:
Authorized Official - First Name:EUNICE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:ALVAREZ GOMEZ
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:310-756-8098
Mailing Address - Street 1:10410 EAGLE CANYON RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92127-7866
Mailing Address - Country:US
Mailing Address - Phone:310-756-8098
Mailing Address - Fax:
Practice Address - Street 1:10410 EAGLE CANYON RD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92127-7866
Practice Address - Country:US
Practice Address - Phone:310-756-8098
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-26
Last Update Date:2014-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA710743311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA710743OtherCALIFORNIA LICENSE