Provider Demographics
NPI:1346754389
Name:GOMEZ MARES, CESAR
Entity Type:Individual
Prefix:
First Name:CESAR
Middle Name:
Last Name:GOMEZ MARES
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 1:4 ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:SAN BRUNO
Mailing Address - State:CA
Mailing Address - Zip Code:94066-1502
Mailing Address - Country:US
Mailing Address - Phone:650-716-7068
Mailing Address - Fax:
Practice Address - Street 1:4 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:SAN BRUNO
Practice Address - State:CA
Practice Address - Zip Code:94066-1502
Practice Address - Country:US
Practice Address - Phone:650-716-7068
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-29
Last Update Date:2017-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician