Provider Demographics
NPI:1124611306
Name:GOMEZ, RAUL ADRIAN
Entity type:Individual
Prefix:
First Name:RAUL
Middle Name:ADRIAN
Last Name:GOMEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 CABRILLO WAY
Mailing Address - Street 2:
Mailing Address - City:SAN BRUNO
Mailing Address - State:CA
Mailing Address - Zip Code:94066-4746
Mailing Address - Country:US
Mailing Address - Phone:650-868-8284
Mailing Address - Fax:
Practice Address - Street 1:130 CABRILLO WAY
Practice Address - Street 2:
Practice Address - City:SAN BRUNO
Practice Address - State:CA
Practice Address - Zip Code:94066-4746
Practice Address - Country:US
Practice Address - Phone:650-868-8284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-18
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program