1316254576 NPI number — LORI ANNE GOMEZ MHRS

Table of content: LORI ANNE GOMEZ MHRS (NPI 1316254576)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316254576 NPI number — LORI ANNE GOMEZ MHRS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GOMEZ
Provider First Name:
LORI ANNE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MHRS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1316254576
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/09/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
516 N KAWEAH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EXETER
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93221-1200
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
559-594-5949
Provider Business Mailing Address Fax Number:
559-592-9250

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
516 N KAWEAH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EXETER
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93221-1200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-594-5949
Provider Business Practice Location Address Fax Number:
559-592-9250
Provider Enumeration Date:
09/09/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)