Provider Demographics
NPI:1093094807
Name:GOMEZ, CRISTINA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CRISTINA
Middle Name:
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3596
Mailing Address - Street 2:
Mailing Address - City:SAN DIMAS
Mailing Address - State:CA
Mailing Address - Zip Code:91773-7596
Mailing Address - Country:US
Mailing Address - Phone:626-224-4490
Mailing Address - Fax:
Practice Address - Street 1:250 W 1ST ST STE 312
Practice Address - Street 2:
Practice Address - City:CLAREMONT
Practice Address - State:CA
Practice Address - Zip Code:91711-4740
Practice Address - Country:US
Practice Address - Phone:626-344-9362
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-10
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31857103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical