Provider Demographics
NPI:1205419371
Name:GOMEZ, LILLIANNA
Entity Type:Individual
Prefix:
First Name:LILLIANNA
Middle Name:
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 1:4210 RIVERWALK PKWY STE 300
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92505-3317
Mailing Address - Country:US
Mailing Address - Phone:951-358-5401
Mailing Address - Fax:
Practice Address - Street 1:4210 RIVERWALK PKWY STE 300
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92505-3317
Practice Address - Country:US
Practice Address - Phone:951-358-5401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-05
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker