Provider Demographics
NPI:1669253696
Name:GOMEZ, MANUEL FELIX JR
Entity type:Individual
Prefix:
First Name:MANUEL
Middle Name:FELIX
Last Name:GOMEZ
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:MANUEL
Other - Middle Name:FELIX
Other - Last Name:GOMEZ
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2821 H ST
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301-1913
Mailing Address - Country:US
Mailing Address - Phone:661-546-6365
Mailing Address - Fax:661-404-8438
Practice Address - Street 1:2821 H ST
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-1913
Practice Address - Country:US
Practice Address - Phone:661-546-6365
Practice Address - Fax:661-404-8438
Is Sole Proprietor?:No
Enumeration Date:2023-10-05
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X, 172V00000X, 390200000X
CA120409104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No172V00000XOther Service ProvidersCommunity Health Worker
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program