Provider Demographics
NPI:1912216391
Name:GOMEZ, DIANA MARIA
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:MARIA
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 1:3407 CANDLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93306-1621
Mailing Address - Country:US
Mailing Address - Phone:661-748-6277
Mailing Address - Fax:
Practice Address - Street 1:1021 4TH ST
Practice Address - Street 2:STE B
Practice Address - City:TAFT
Practice Address - State:CA
Practice Address - Zip Code:93268-2433
Practice Address - Country:US
Practice Address - Phone:661-765-7025
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-01
Last Update Date:2010-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker