Provider Demographics
NPI:1265579841
Name:GOMES, ERMA LEE (PSYCH TECK)
Entity type:Individual
Prefix:MRS
First Name:ERMA
Middle Name:LEE
Last Name:GOMES
Suffix:
Gender:F
Credentials:PSYCH TECK
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2915 KELP LN
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93035
Mailing Address - Country:US
Mailing Address - Phone:805-681-5244
Mailing Address - Fax:
Practice Address - Street 1:2915 KELP LN
Practice Address - Street 2:315 CAMINO DEL REMEDIO SANTA BARBARA
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93035
Practice Address - Country:US
Practice Address - Phone:805-681-5244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT21005374700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374700000XNursing Service Related ProvidersTechnician