1689823262 NPI number — DR. CHASKA LATOYA GOMEZ PSYD

Table of content: DR. CHASKA LATOYA GOMEZ PSYD (NPI 1689823262)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689823262 NPI number — DR. CHASKA LATOYA GOMEZ PSYD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GOMEZ
Provider First Name:
CHASKA
Provider Middle Name:
LATOYA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PSYD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BARKSDALE
Provider Other First Name:
CHASKA
Provider Other Middle Name:
LATOYA
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PSYD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1689823262
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/06/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
216 MERCURY ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HONOLULU
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96818-5932
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
908-528-3500
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 JARRETT WHITE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TRIPLER ARMY MEDICAL CENTER
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96859
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-433-2990
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/18/2008

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: 103TC0700X , with the licence number:  0810004369 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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