Provider Demographics
NPI:1467506055
Name:POMERANTZ, GILA RACHEL (MSW)
Entity Type:Individual
Prefix:MRS
First Name:GILA
Middle Name:RACHEL
Last Name:POMERANTZ
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1495 W SHAW AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93711
Mailing Address - Country:US
Mailing Address - Phone:559-905-5251
Mailing Address - Fax:559-436-1113
Practice Address - Street 1:1495 W SHAW AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-3608
Practice Address - Country:US
Practice Address - Phone:559-905-5251
Practice Address - Fax:559-436-1113
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2012-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS190491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHSP40130FMedicaid
CA05330Medicare ID - Type UnspecifiedMEDICARE NUMBER