Provider Demographics
NPI:1477057743
Name:GOMEZ, YASMIN (MA)
Entity Type:Individual
Prefix:MS
First Name:YASMIN
Middle Name:
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:326 HARRIS AVE
Mailing Address - Street 2:
Mailing Address - City:RODEO
Mailing Address - State:CA
Mailing Address - Zip Code:94572-1039
Mailing Address - Country:US
Mailing Address - Phone:510-734-9275
Mailing Address - Fax:
Practice Address - Street 1:35 E 10TH ST STE 1
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95376-4058
Practice Address - Country:US
Practice Address - Phone:510-782-0950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-21
Last Update Date:2018-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst