Provider Demographics
NPI:1659149664
Name:GOMEZ RIVAS, REBECA (DH60960531)
Entity Type:Individual
Prefix:
First Name:REBECA
Middle Name:
Last Name:GOMEZ RIVAS
Suffix:
Gender:F
Credentials:DH60960531
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2055
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-2055
Mailing Address - Country:US
Mailing Address - Phone:206-372-0424
Mailing Address - Fax:
Practice Address - Street 1:2503 197TH PL SW
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-6928
Practice Address - Country:US
Practice Address - Phone:206-372-0424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-19
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADH60960531124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist