Provider Demographics
NPI:1376435255
Name:GOMEZ GOMEZ, DAVE AXEL
Entity type:Individual
Prefix:
First Name:DAVE AXEL
Middle Name:
Last Name:GOMEZ GOMEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10213 MIGUELITO RD
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95127-2715
Mailing Address - Country:US
Mailing Address - Phone:408-480-4603
Mailing Address - Fax:
Practice Address - Street 1:20555 PROSPECT RD
Practice Address - Street 2:
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014-5212
Practice Address - Country:US
Practice Address - Phone:650-930-9550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-16
Last Update Date:2025-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program