Provider Demographics
NPI:1487454336
Name:GOMEZ BENAVIDES, LUIZ ENRIQUE
Entity type:Individual
Prefix:
First Name:LUIZ
Middle Name:ENRIQUE
Last Name:GOMEZ BENAVIDES
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 1:3909 TERRACINA DR
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-0150
Mailing Address - Country:US
Mailing Address - Phone:951-203-0819
Mailing Address - Fax:
Practice Address - Street 1:6800 INDIANA AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-4269
Practice Address - Country:US
Practice Address - Phone:951-782-0040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-18
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner