Provider Demographics
NPI:1396923645
Name:GOMEZ, KIMBERLY PAIGE (OTR/L)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:PAIGE
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:PAIGE
Other - Last Name:VAUGHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:28093 SMYTH DR
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-4023
Mailing Address - Country:US
Mailing Address - Phone:661-295-0181
Mailing Address - Fax:661-295-9776
Practice Address - Street 1:28093 SMYTH DR
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-4023
Practice Address - Country:US
Practice Address - Phone:661-295-0181
Practice Address - Fax:661-295-9776
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-07
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6991174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist