Provider Demographics
NPI:1306547260
Name:GOMEZ, ROSEANN MERIE
Entity type:Individual
Prefix:
First Name:ROSEANN
Middle Name:MERIE
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10232 COTTONWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:HESPERIA
Mailing Address - State:CA
Mailing Address - Zip Code:92345-2708
Mailing Address - Country:US
Mailing Address - Phone:909-371-9307
Mailing Address - Fax:
Practice Address - Street 1:25710 BARTON RD
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-3874
Practice Address - Country:US
Practice Address - Phone:909-799-0591
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-16
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician