Provider Demographics
NPI:1437787249
Name:GOMEZ, BRENDA L (PSYD)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:L
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 1:7364 SEAFARER PL
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92011-4672
Mailing Address - Country:US
Mailing Address - Phone:312-451-8633
Mailing Address - Fax:
Practice Address - Street 1:7364 SEAFARER PL
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92011-4672
Practice Address - Country:US
Practice Address - Phone:312-451-8633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-28
Last Update Date:2020-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31708103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist