Provider Demographics
NPI:1629460076
Name:GIASSON-GOMEZ, EUGENIE MICHELLE (DC)
Entity Type:Individual
Prefix:
First Name:EUGENIE
Middle Name:MICHELLE
Last Name:GIASSON-GOMEZ
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15100 LOS GATOS BLVD STE 1
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-2028
Mailing Address - Country:US
Mailing Address - Phone:408-356-0270
Mailing Address - Fax:408-356-0273
Practice Address - Street 1:15100 LOS GATOS BLVD STE 1
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-2028
Practice Address - Country:US
Practice Address - Phone:408-356-0270
Practice Address - Fax:408-356-0273
Is Sole Proprietor?:No
Enumeration Date:2015-02-23
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33165111NP0017X, 111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NP0017XChiropractic ProvidersChiropractorPediatric Chiropractor
No111NN1001XChiropractic ProvidersChiropractorNutrition