Provider Demographics
NPI:1215178918
Name:GOMEZ, RUBY
Entity Type:Individual
Prefix:
First Name:RUBY
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 1:1125 E LASSEN ST
Mailing Address - Street 2:
Mailing Address - City:AVENAL
Mailing Address - State:CA
Mailing Address - Zip Code:93204-2100
Mailing Address - Country:US
Mailing Address - Phone:559-836-2856
Mailing Address - Fax:
Practice Address - Street 1:1125 E LASSEN ST
Practice Address - Street 2:
Practice Address - City:AVENAL
Practice Address - State:CA
Practice Address - Zip Code:93204-2100
Practice Address - Country:US
Practice Address - Phone:559-836-2856
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-10
Last Update Date:2009-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)