Provider Demographics
NPI:1508530452
Name:GOMEZ, EPIMAQUIO
Entity Type:Individual
Prefix:MR
First Name:EPIMAQUIO
Middle Name:
Last Name:GOMEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4837 CHAPMAN DR
Mailing Address - Street 2:
Mailing Address - City:GUADALUPE
Mailing Address - State:CA
Mailing Address - Zip Code:93434-1763
Mailing Address - Country:US
Mailing Address - Phone:805-280-3577
Mailing Address - Fax:
Practice Address - Street 1:401 E CYPRESS AVE
Practice Address - Street 2:
Practice Address - City:LOMPOC
Practice Address - State:CA
Practice Address - Zip Code:93436-6806
Practice Address - Country:US
Practice Address - Phone:805-737-6690
Practice Address - Fax:805-737-6691
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-04
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator