Shane Lex Gomes, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PSY20625 Issued in CA

Practice address

335 Redondo Ave
Long Beach, CA 90814-2652

Phone

(562) 434-3030

Fax

(562) 434-3212

NPI assigned

Nov 7, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Branko Radisavljevic M.D. Inc.

  • Psychiatry Physician
  • Long Beach, CA
  • NPI 1982941902
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162857600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1253232000000",
    "number": "1508935255",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "335 REDONDO AVE",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908142652",
            "telephone_number": "562-434-3030",
            "fax_number": "562-434-3212"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "335 REDONDO AVE",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908142652",
            "telephone_number": "562-434-3030",
            "fax_number": "562-434-3212"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOMES",
        "first_name": "SHANE",
        "middle_name": "LEX",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-07",
        "last_updated": "2009-09-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY20625",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA - PROVIDER #",
            "identifier": "0009104062",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD PROVIDER #",
            "identifier": "OPL206250",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Christopher Golveo
• Lee M Gomberg, PH.D.
• Gomes Tobon Dental Corporation
• Cleber Januario Gomes, DDS
• Donna Rose Gomes, RRW
• Brittney Gomez Jimenez
• Lucylibeth Claudia Gomez Marroquin
• Carlos Andres Gomez Noguera, MD
• Brenda Gomez Salcedo
• Sonia Yolanda Gomez Sanchez

• Clinical Psychologist in Long Beach, CA
• Providers in Long Beach, CA by specialty
• Clinical Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.