Provider Demographics
NPI:1598462863
Name:GOMEZ, PEDRO JR
Entity Type:Individual
Prefix:MR
First Name:PEDRO
Middle Name:
Last Name:GOMEZ
Suffix:JR
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 1:2586 12TH PL SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-2536
Mailing Address - Country:US
Mailing Address - Phone:971-720-6645
Mailing Address - Fax:
Practice Address - Street 1:154 CONNECTICUT AVE SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97317-5589
Practice Address - Country:US
Practice Address - Phone:971-720-6645
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-07
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)