Provider Demographics
NPI:1558617597
Name:GOMEZ, DIANA C
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:C
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 HARBOR BLVD
Mailing Address - Street 2:SUITE E
Mailing Address - City:BELMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94002-4047
Mailing Address - Country:US
Mailing Address - Phone:650-802-6414
Mailing Address - Fax:650-802-6440
Practice Address - Street 1:400 HARBOR BLVD
Practice Address - Street 2:SUITE E
Practice Address - City:BELMONT
Practice Address - State:CA
Practice Address - Zip Code:94002-4047
Practice Address - Country:US
Practice Address - Phone:650-802-6414
Practice Address - Fax:650-802-6440
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-27
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health