Provider Demographics
NPI:1902780489
Name:GOMEZ, RAQUEL ARGENTINA
Entity type:Individual
Prefix:
First Name:RAQUEL
Middle Name:ARGENTINA
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3554 SUNSET LN UNIT 32
Mailing Address - Street 2:
Mailing Address - City:SAN YSIDRO
Mailing Address - State:CA
Mailing Address - Zip Code:92173-4506
Mailing Address - Country:US
Mailing Address - Phone:619-361-7103
Mailing Address - Fax:619-785-3404
Practice Address - Street 1:13553 VISTA SAGE LN
Practice Address - Street 2:
Practice Address - City:JAMUL
Practice Address - State:CA
Practice Address - Zip Code:91935-3023
Practice Address - Country:US
Practice Address - Phone:619-361-7103
Practice Address - Fax:619-785-3404
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-05
Last Update Date:2025-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZ44797631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice