Provider Demographics
NPI:1710371067
Name:GOMEZ, LORENA
Entity Type:Individual
Prefix:
First Name:LORENA
Middle Name:
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12322 CLEARGLEN AVE
Mailing Address - Street 2:APT. #3
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90604-3872
Mailing Address - Country:US
Mailing Address - Phone:562-923-4545
Mailing Address - Fax:562-943-5065
Practice Address - Street 1:12322 CLEARGLEN AVE
Practice Address - Street 2:APT. #3
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90604-3872
Practice Address - Country:US
Practice Address - Phone:562-923-4545
Practice Address - Fax:562-943-5065
Is Sole Proprietor?:No
Enumeration Date:2015-03-25
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner