Provider Demographics
NPI:1932882859
Name:GOMEZ, DOMINIC (CRT)
Entity Type:Individual
Prefix:
First Name:DOMINIC
Middle Name:
Last Name:GOMEZ
Suffix:
Gender:M
Credentials:CRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7526 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93722-2310
Mailing Address - Country:US
Mailing Address - Phone:626-626-6546
Mailing Address - Fax:
Practice Address - Street 1:1601 PETERSEN AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95129-4844
Practice Address - Country:US
Practice Address - Phone:408-253-7502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-08
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2278G1100XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedGeneral Care