Provider Demographics
NPI:1982793220
Name:BAKKUM, ALICIA LYNN GOMEZ (NP)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:LYNN GOMEZ
Last Name:BAKKUM
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ALICIA
Other - Middle Name:LYNN
Other - Last Name:GOMEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:333 MARGARET CT
Mailing Address - Street 2:
Mailing Address - City:BAY POINT
Mailing Address - State:CA
Mailing Address - Zip Code:94565-3055
Mailing Address - Country:US
Mailing Address - Phone:925-261-1688
Mailing Address - Fax:
Practice Address - Street 1:2700 GRANT ST
Practice Address - Street 2:SUITE 102
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-2266
Practice Address - Country:US
Practice Address - Phone:925-674-2052
Practice Address - Fax:925-674-2076
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14719363LF0000X
CA2013364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Not Answered364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist