Provider Demographics
NPI:1205473741
Name:GOMEZ-DEVINE, THERESA ROSE (FNP, RN, ATC)
Entity type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:ROSE
Last Name:GOMEZ-DEVINE
Suffix:
Gender:F
Credentials:FNP, RN, ATC
Other - Prefix:
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Other - Last Name:
Other - Suffix:
Other - Last Name Type:
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Mailing Address - Street 1:10881 CITRUS DR
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93004-3453
Mailing Address - Country:US
Mailing Address - Phone:408-375-6922
Mailing Address - Fax:
Practice Address - Street 1:10881 CITRUS DR
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93004-3453
Practice Address - Country:US
Practice Address - Phone:408-375-6922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-03
Last Update Date:2025-11-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA95036932363LF0000X
2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer