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LOURDES CAROLINA GOMEZ RD
NPI 1104498328
Dietitian, Registered in Montclair, CA

Active since July 15, 2021
9612 HELENA AVE, MONTCLAIR, CA 91763(909) 541-8612 Get Directions Write a Review

NPPES record last updated: July 8, 2024. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Jul 8, 2024, Nov 18, 2022, Jul 15, 2021 (3 updates tracked since 2021).

About Lourdes Carolina Gomez Rd NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

LOURDES CAROLINA GOMEZ RD (NPI 1104498328) is an individual dietitian, registered in Montclair, California, licensed in California (86169226) and active in the NPI registry since July 2021. She maintains a secondary practice location in Los Angeles.

NPPES Registry Identity

NPI1104498328
Entity TypeIndividualFemale
Primary Taxonomy133V00000X
Provider Legal NameLOURDES CAROLINA GOMEZCredential: RD
Location Address9612 HELENA AVEMontclair, CA 91763-2210
Mailing Address3775 E 11th StLong Beach, CA 90804-6430 · (909) 541-8612
Phone(909) 541-8612
Sole ProprietorYes
Enumeration DateJuly 15, 2021
Last NPPES UpdateJuly 8, 20243 updates tracked since enumeration
NPPES CertifiedJuly 8, 2024
✔ NPI 1104498328 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDietitian, RegisteredDietary & Nutritional Service Providers
Taxonomy Code133V00000X
License✔ Licensed in CA · 86169226
Definition
A Registered Dietitian (RD)/Registered Dietitian Nutritionist (RDN) is an individual uniquely trained in the science of nutrition and practice of dietetics to design and provide medical nutrition therapy (MNT) and other evidence-based applications of the Nutrition Care Process (NCP) that exemplify the profession's systematic approach to providing high quality nutrition care. Registered dietitians provide MNT for the purpose of disease prevention or management, or to treat or rehabilitate an illness, injury, or condition, with the use of specific, indicated physical and cognitive nutrition care services comprised of one or more of the following aspects of the NCP: nutrition assessment/reassessment, nutrition diagnosis, nutrition intervention (e.g., nutrition counseling, therapeutic diet ordering, and nutrition education) and nutrition monitoring and evaluation.
9612 HELENA AVE, Montclair, CA 91763
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Secondary Practice Location 1

Location 11414 S Grand Ave Ste 380Los Angeles, CA 90015-3072 · Phone (888) 311-6322

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Lourdes Carolina Gomez Rd is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Medicare Billing Reassignment

Medicare enrollment records show Lourdes Gomez reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Northeast Community Clinic
28 mi
Federally Qualified Health Center (FQHC)
5420 N FIGUEROA ST
Los Angeles, CA 90042
  • Reassigned Medicare billing, California enrollment
  • 45 clinicians in this Medicare group
NPI 1801447958 (323) 256-3884

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

YESENIA NORIEGA GARCIA
Behavior Technician
9612 HELENA AVE
MONTCLAIR, CA 91763
San Bernardino County (760) 261-3060

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Lourdes Gomez's NPI number?

The NPI number for Lourdes Gomez is 1104498328. It was assigned to this individual provider in the NPPES registry on July 15, 2021.

Where is Lourdes Gomez located?

Lourdes Gomez practices at 9612 Helena Ave, Montclair, CA 91763. The listed phone number is (909) 541-8612.

What is Lourdes Gomez's specialty?

The primary specialty registered for this NPI is Dietitian, Registered with taxonomy code 133V00000X.

Is Lourdes Gomez enrolled in Medicare?

Yes. Lourdes Gomez is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Lourdes Gomez's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Lourdes Gomez reassigns Medicare benefits to Northeast Community Clinic (Los Angeles, CA). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Lourdes Gomez's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Lourdes Gomez was last updated on July 8, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.