Provider Demographics
NPI:1043671357
Name:GAMEZ, KARLA
Entity Type:Individual
Prefix:
First Name:KARLA
Middle Name:
Last Name:GAMEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10966 LOU DILLON AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90059-1359
Mailing Address - Country:US
Mailing Address - Phone:310-886-9695
Mailing Address - Fax:
Practice Address - Street 1:10966 LOU DILLON AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90059-1359
Practice Address - Country:US
Practice Address - Phone:310-886-9695
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-14
Last Update Date:2024-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA02768010OtherDRUG MEDI-CAL