Provider Demographics
NPI:1760823322
Name:GOMEZ, ROCIO (LVN)
Entity Type:Individual
Prefix:
First Name:ROCIO
Middle Name:
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:ROSIE
Other - Middle Name:
Other - Last Name:GOMEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:10986 WAGON TRAIN RD
Mailing Address - Street 2:
Mailing Address - City:PHELAN
Mailing Address - State:CA
Mailing Address - Zip Code:92371-8169
Mailing Address - Country:US
Mailing Address - Phone:323-828-0494
Mailing Address - Fax:
Practice Address - Street 1:681 S PARKER ST STE 150
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-4761
Practice Address - Country:US
Practice Address - Phone:714-744-0900
Practice Address - Fax:877-593-5583
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-11
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA270659164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse