Provider Demographics
NPI:1659849826
Name:GOMEZ, BEATRIZ (N/A)
Entity Type:Individual
Prefix:
First Name:BEATRIZ
Middle Name:
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:N/A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1405 SPRUCE ST STE A
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92507-2410
Mailing Address - Country:US
Mailing Address - Phone:951-715-5050
Mailing Address - Fax:951-784-4986
Practice Address - Street 1:2055 N PERRIS BLVD # C
Practice Address - Street 2:
Practice Address - City:PERRIS
Practice Address - State:CA
Practice Address - Zip Code:92571-2509
Practice Address - Country:US
Practice Address - Phone:951-715-5050
Practice Address - Fax:951-784-4986
Is Sole Proprietor?:No
Enumeration Date:2018-11-06
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMPSS-EWITRC175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist