Samuel Gomez

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

License

1-19-36579 Issued in CA

Practice address

2326 Oak Flat Rd
San Jose, CA 95131-1929

Phone

(669) 252-6423

NPI assigned

Apr 11, 2018

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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.

• Aglow ABA LLC

  • Behavior Analyst
  • Sacramento, CA
  • NPI 1124898549
  NPD Authorized official

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

{
    "created_epoch": "1523404800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1615248000000",
    "number": "1831696368",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1485 SARATOGA AVE STE 200",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951294965",
            "telephone_number": "877-991-0009",
            "fax_number": "877-207-9553"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2326 OAK FLAT RD",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951311929",
            "telephone_number": "669-252-6423"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOMEZ",
        "first_name": "SAMUEL",
        "name_prefix": "Mr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-04-11",
        "last_updated": "2021-03-09",
        "certification_date": "2021-03-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "CA",
            "license": "1-19-36579",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Martha Gomez
• Olivia Gomez
• Pablo Gomez
• Robert Anthony Gomez
• Roini Kinari Gomez
• Talya Lizzay Gomez
• Yamilex Gomez
• Cristina Salvador Goncalves, PSY.D.
• Jasdev Singh Gondal, M.D.
• Tesfaye Gebrekristos Gondel, MD

• Behavior Analyst in San Jose, CA
• Providers in San Jose, CA by specialty
• Behavior Analyst in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2021; 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.