Basic Information
| Provider Information | |||||||||
| NPI: | 1700058757 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GOMEZ | ||||||||
| FirstName: | CESAR | ||||||||
| MiddleName: | MAURICIO | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1323 | ||||||||
| Address2: | |||||||||
| City: | PASCO | ||||||||
| State: | WA | ||||||||
| PostalCode: | 993011323 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5095472204 | ||||||||
| FaxNumber: | 5095428836 | ||||||||
| Practice Location | |||||||||
| Address1: | 720 W COURT ST | ||||||||
| Address2: | SUITE 8 | ||||||||
| City: | PASCO | ||||||||
| State: | WA | ||||||||
| PostalCode: | 993014178 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5095456506 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/31/2008 | ||||||||
| LastUpdateDate: | 03/31/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | RC00059095 | WA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.