Provider Demographics
NPI:1942870134
Name:GOMEZ, KATRINA ASSUNTA ROCHON (CLC)
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:ASSUNTA ROCHON
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:773 CHARLTON RD
Mailing Address - Street 2:
Mailing Address - City:BALLSTON LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:12019-2803
Mailing Address - Country:US
Mailing Address - Phone:541-361-0339
Mailing Address - Fax:
Practice Address - Street 1:773 CHARLTON RD
Practice Address - Street 2:
Practice Address - City:BALLSTON LAKE
Practice Address - State:NY
Practice Address - Zip Code:12019-2803
Practice Address - Country:US
Practice Address - Phone:541-361-0339
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-29
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY329140174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN