Provider Demographics
NPI:1518665595
Name:GOMEZ, GINA MICHELLE
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:MICHELLE
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:GINA
Other - Middle Name:MICHELLE
Other - Last Name:HOERIG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2741 W MISSION CT
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93277-7258
Mailing Address - Country:US
Mailing Address - Phone:559-545-9188
Mailing Address - Fax:
Practice Address - Street 1:1235 E ST
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93706-2024
Practice Address - Country:US
Practice Address - Phone:559-268-6261
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-20
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA582440163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)