Provider Demographics
NPI:1376787887
Name:GOMEZ, SOFIA M
Entity Type:Individual
Prefix:MS
First Name:SOFIA
Middle Name:M
Last Name:GOMEZ
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 1:8526 GRAPE ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90001-4134
Mailing Address - Country:US
Mailing Address - Phone:323-586-6401
Mailing Address - Fax:323-583-0189
Practice Address - Street 1:8526 GRAPE ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90001-4134
Practice Address - Country:US
Practice Address - Phone:323-586-6401
Practice Address - Fax:323-583-0189
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-28
Last Update Date:2009-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator