Provider Demographics
NPI:1710652375
Name:GOMEZ, JESSICA ARACELI (PA-C)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:ARACELI
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1027 E A ST
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:CA
Mailing Address - Zip Code:95361-2711
Mailing Address - Country:US
Mailing Address - Phone:209-541-4614
Mailing Address - Fax:
Practice Address - Street 1:1027 E A ST
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:CA
Practice Address - Zip Code:95361-2711
Practice Address - Country:US
Practice Address - Phone:209-541-4614
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-14
Last Update Date:2021-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant