Provider Demographics
NPI:1184936551
Name:GOMAR, JESUS
Entity type:Individual
Prefix:
First Name:JESUS
Middle Name:
Last Name:GOMAR
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 1:711 E GROVE ST
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767-1547
Mailing Address - Country:US
Mailing Address - Phone:323-497-5376
Mailing Address - Fax:
Practice Address - Street 1:711 E GROVE ST
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-1547
Practice Address - Country:US
Practice Address - Phone:323-497-5376
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-13
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor