Provider Demographics
NPI:1346764784
Name:GOMES, ASHLEY ROSE
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:ROSE
Last Name:GOMES
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 1:1756 COBBLESTONE DR
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95901-8229
Mailing Address - Country:US
Mailing Address - Phone:707-772-7510
Mailing Address - Fax:
Practice Address - Street 1:1756 COBBLESTONE DR
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:CA
Practice Address - Zip Code:95901-8229
Practice Address - Country:US
Practice Address - Phone:707-772-7510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician