Provider Demographics
NPI:1235294992
Name:GALLEGOS SKOMAL, MARIA (MFT)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:GALLEGOS SKOMAL
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:DEL REFUGIO
Other - Last Name:SKOMAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MFT
Mailing Address - Street 1:3344 KENNELWORTH LN
Mailing Address - Street 2:
Mailing Address - City:BONITA
Mailing Address - State:CA
Mailing Address - Zip Code:91902-1508
Mailing Address - Country:US
Mailing Address - Phone:619-472-3918
Mailing Address - Fax:
Practice Address - Street 1:815 3RD AVE
Practice Address - Street 2:SUITE 214
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-1307
Practice Address - Country:US
Practice Address - Phone:619-691-1880
Practice Address - Fax:619-691-5937
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT 43149106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist