Most Relevant Information
Provider Data
| NPI Number: | 1003244310 |
| Provider Name: | STEPHANIE GOMEZ |
| Entity Type: | Individual |
| Taxonomy Code: | 167G00000X |
| Specialty: | Licensed Psychiatric Technician |
| License Number: | 33237 |
Most Important Dates
| Enumeration Date: | 10/23/2013 |
| Last Updated: | 07/07/2014 |
Provider Practice Location
7458 SANTA BARBARA DR
ROHNERT PARK
CA
949283840
Practice Location Phone/Fax
| Phone: | 7075654970 |
| Fax: |
Provider Mailing Location
3322 CHANATE RD
SANTA ROSA
CA
954041708
Provider Mailing Phone/Fax
| Phone: | 7075654970 |
| Fax: |