Provider Demographics
NPI:1407576028
Name:GOMEZ, DANIEL NELSON (BA)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:NELSON
Last Name:GOMEZ
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 N JOHNSON AVE STE P
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92020-2589
Mailing Address - Country:US
Mailing Address - Phone:619-441-1907
Mailing Address - Fax:
Practice Address - Street 1:700 N JOHNSON AVE STE P
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-2589
Practice Address - Country:US
Practice Address - Phone:619-441-1907
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-01
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 225400000X
CAMPSS-USVCEY175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No175T00000XOther Service ProvidersPeer Specialist