Provider Demographics
NPI:1407314040
Name:GOMEZ, FERNANDO (DC)
Entity Type:Individual
Prefix:
First Name:FERNANDO
Middle Name:
Last Name:GOMEZ
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2034 NORMA ST
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93036-2711
Mailing Address - Country:US
Mailing Address - Phone:805-889-7873
Mailing Address - Fax:
Practice Address - Street 1:4562 WESTINGHOUSE ST STE D
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-5797
Practice Address - Country:US
Practice Address - Phone:805-256-1688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-02
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34478111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor