Provider Demographics
NPI:1114539939
Name:GOZOS, HUGO (PMHNP)
Entity Type:Individual
Prefix:
First Name:HUGO
Middle Name:
Last Name:GOZOS
Suffix:
Gender:M
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 SANTA MONICA BLVD STE 230
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90401-2625
Mailing Address - Country:US
Mailing Address - Phone:310-993-4103
Mailing Address - Fax:805-494-8385
Practice Address - Street 1:701 SANTA MONICA BLVD STE 230
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90401-2625
Practice Address - Country:US
Practice Address - Phone:310-993-4103
Practice Address - Fax:805-494-8385
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-21
Last Update Date:2020-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95015186363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health