Provider Demographics
NPI:1730478223
Name:GOMEZ, KIMBERLY JUNE
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:JUNE
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 1:391 TUDOR LANE
Mailing Address - Street 2:
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-1656
Mailing Address - Country:US
Mailing Address - Phone:330-631-1368
Mailing Address - Fax:
Practice Address - Street 1:8064 SOUTH AVENUE
Practice Address - Street 2:GREENBRIAR HEALTH CARE
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44512
Practice Address - Country:US
Practice Address - Phone:330-726-2391
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-05
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH501104350406376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide