Provider Demographics
NPI:1609374859
Name:GOMEZ, CAROLINA (LVN)
Entity Type:Individual
Prefix:
First Name:CAROLINA
Middle Name:
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6508 WALKER AVE APT B
Mailing Address - Street 2:
Mailing Address - City:BELL
Mailing Address - State:CA
Mailing Address - Zip Code:90201-2847
Mailing Address - Country:US
Mailing Address - Phone:323-617-8544
Mailing Address - Fax:
Practice Address - Street 1:6508 WALKER AVE APT B
Practice Address - Street 2:
Practice Address - City:BELL
Practice Address - State:CA
Practice Address - Zip Code:90201-2847
Practice Address - Country:US
Practice Address - Phone:323-617-8544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-23
Last Update Date:2018-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA280948164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse