Provider Demographics
NPI:1295039766
Name:GOMEZ-SABALLOZ, JACQUELINE (CMT)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:GOMEZ-SABALLOZ
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:902 ELLISON ST
Mailing Address - Street 2:APT 612
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22046-3021
Mailing Address - Country:US
Mailing Address - Phone:202-714-2227
Mailing Address - Fax:
Practice Address - Street 1:5610 LEE HWY
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22207-1445
Practice Address - Country:US
Practice Address - Phone:703-703-2375
Practice Address - Fax:703-532-1172
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-27
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019005403225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist