Provider Demographics
NPI:1376310987
Name:GOMEZ, FIONA SOPHIA
Entity Type:Individual
Prefix:
First Name:FIONA
Middle Name:SOPHIA
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 1:3785 BAKER LN STE 201
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-5454
Mailing Address - Country:US
Mailing Address - Phone:775-560-4825
Mailing Address - Fax:
Practice Address - Street 1:150 E MAIN ST STE 430
Practice Address - Street 2:
Practice Address - City:FERNLEY
Practice Address - State:NV
Practice Address - Zip Code:89408-7744
Practice Address - Country:US
Practice Address - Phone:775-560-4825
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-05
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician