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Provider Information for 1063930105

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know

MS. ALYCIA MARIE GOMEZ M.ED.

Gender: FEMALE

Individual NPI: 1063930105

Calendar   Last Updated:  2017-09-08
  Certification Date: 

Details

Name Value
NPI 1063930105
Enumeration Date 2017-09-08
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address 545 ESTUDILLO AVE
SAN LEANDRO, CA 94577-4611
United States

Phone: 510-352-9200 | Fax: 510-352-3120
View Map External Link
Primary Practice Address 545 ESTUDILLO AVE
SAN LEANDRO, CA 94577-4611
United States

Phone: #(510) 352-9200 | Fax: 510-352-3120
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 172V00000X - Community Health Worker