Provider Demographics
NPI:1831585009
Name:GOMEZ, JEANNETTE (MS,RDN)
Entity type:Individual
Prefix:MS
First Name:JEANNETTE
Middle Name:
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:MS,RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10305 CHAPEL HILL BLVD APT D1020
Mailing Address - Street 2:
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99301-9200
Mailing Address - Country:US
Mailing Address - Phone:509-378-9002
Mailing Address - Fax:
Practice Address - Street 1:203 W 8TH AVE
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-5630
Practice Address - Country:US
Practice Address - Phone:509-221-5442
Practice Address - Fax:509-221-5140
Is Sole Proprietor?:No
Enumeration Date:2015-04-14
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI 60553589133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered