Provider Demographics
NPI:1497725998
Name:GOMEZ, SOPHIE (MD)
Entity Type:Individual
Prefix:DR
First Name:SOPHIE
Middle Name:
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3525 W 10TH CT
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99338-2048
Mailing Address - Country:US
Mailing Address - Phone:206-349-6874
Mailing Address - Fax:
Practice Address - Street 1:3525 W 10TH CT
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99338-2048
Practice Address - Country:US
Practice Address - Phone:206-349-6874
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00031624207R00000X, 207RA0401X, 2083A0300X, 207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
No2083A0300XAllopathic & Osteopathic PhysiciansPreventive MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA077333500OtherOWCP FECA
WA0202009OtherL&I
WA8184913Medicaid
WA0202009OtherL&I
WA077333500OtherOWCP FECA
WAG8882807Medicare PIN
WAG8856987Medicare PIN