Active NPI
Freddy Reyes Gomez
- Community Health Worker
- San Bernardino, CA
National Provider Identifier
1366804791
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community Health Worker
- Practice address
- 572 N Arrowhead Ave
San Bernardino, CA 92401-1251 - Phone
- (909) 781-1854
- Fax
- (909) 266-2790
- NPI assigned
- Mar 24, 2016
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Case Manager/Care Coordinator | 171M00000X | D8406174 | CA | |
| Community Health Worker | 172V00000X | Primary |
Addresses
Primary practice location
572 N Arrowhead Ave
San Bernardino, CA 92401-1251
Mailing address
572 N Arrowhead Ave
San Bernardino, CA 92401-1251
Phone (909) 781-1854
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D8406174 | CA | MD | Case Manager/Care Coordinator |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1458777600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1687219200000",
"number": "1366804791",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "572 N ARROWHEAD AVE",
"city": "SAN BERNARDINO",
"state": "CA",
"postal_code": "924011251",
"telephone_number": "909-781-1854",
"fax_number": "909-266-2790"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "572 N ARROWHEAD AVE",
"city": "SAN BERNARDINO",
"state": "CA",
"postal_code": "924011251",
"telephone_number": "909-781-1854",
"fax_number": "909-266-2790"
}
],
"practiceLocations": [],
"basic": {
"last_name": "REYES GOMEZ",
"first_name": "FREDDY",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2016-03-24",
"last_updated": "2023-06-20",
"certification_date": "2023-06-20",
"status": "A"
},
"taxonomies": [
{
"code": "171M00000X",
"taxonomy_group": "",
"desc": "Case Manager/Care Coordinator",
"state": "CA",
"license": "D8406174",
"primary": false
},
{
"code": "172V00000X",
"taxonomy_group": "",
"desc": "Community Health Worker",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Bernardino, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.