Provider Demographics
NPI:1932748571
Name:GOMEZ, DEBORAH J (RN)
Entity type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:J
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:427 N EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91762-3427
Mailing Address - Country:US
Mailing Address - Phone:909-957-6818
Mailing Address - Fax:
Practice Address - Street 1:427 N EUCLID AVE
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91762-3427
Practice Address - Country:US
Practice Address - Phone:909-957-6818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-30
Last Update Date:2019-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFBN2090011542OtherFICTITIOUS BUSINESS NUMBER