Provider Demographics
NPI:1093198012
Name:GOMEZ MARMOLEJO, MARIA PILAR
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:PILAR
Last Name:GOMEZ MARMOLEJO
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 1:11311 JERRY LN
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92840-3447
Mailing Address - Country:US
Mailing Address - Phone:714-679-7296
Mailing Address - Fax:
Practice Address - Street 1:11311 JERRY LN
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92840-3447
Practice Address - Country:US
Practice Address - Phone:714-679-7296
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-08
Last Update Date:2015-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist