Provider Demographics
NPI:1891961793
Name:GOMEZ, SHARON L (RFOM)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:L
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:RFOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6001 TELEGRAPH AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-1310
Mailing Address - Country:US
Mailing Address - Phone:510-658-2062
Mailing Address - Fax:510-658-7779
Practice Address - Street 1:2190 MERIDIAN PARK BLVD
Practice Address - Street 2:E
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-5789
Practice Address - Country:US
Practice Address - Phone:925-827-2062
Practice Address - Fax:925-827-2503
Is Sole Proprietor?:No
Enumeration Date:2008-05-01
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RFOM 0103225000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter