Provider Demographics
NPI:1760057301
Name:GOMEZ, CRISTOBAL
Entity Type:Individual
Prefix:
First Name:CRISTOBAL
Middle Name:
Last Name:GOMEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8624 PACIFIC AVE APT 6
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98444-6412
Mailing Address - Country:US
Mailing Address - Phone:253-255-0737
Mailing Address - Fax:
Practice Address - Street 1:8624 PACIFIC AVE APT 6
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98444-6412
Practice Address - Country:US
Practice Address - Phone:253-255-0737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-25
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter