1124871801 NPI number — VIRIDIANA SIMONA VAN DEN HENGEL-GOMEZ PA65426

Table of content: VIRIDIANA SIMONA VAN DEN HENGEL-GOMEZ PA65426 (NPI 1124871801)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124871801 NPI number — VIRIDIANA SIMONA VAN DEN HENGEL-GOMEZ PA65426

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VAN DEN HENGEL-GOMEZ
Provider First Name:
VIRIDIANA
Provider Middle Name:
SIMONA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA65426
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
VAN DEN HENGEL-GOMEZ
Provider Other First Name:
VIRIDIANA
Provider Other Middle Name:
SIMONA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PA65426
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1124871801
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/02/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
224 RALEIGH DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VACAVILLE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95687-6636
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
530-787-3454
Provider Business Mailing Address Fax Number:
530-795-3054

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
172 E GRANT AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WINTERS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95694-1780
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-734-2145
Provider Business Practice Location Address Fax Number:
530-795-3054
Provider Enumeration Date:
04/10/2024

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: 363A00000X , with the licence number:  PA65426 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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