Provider Demographics
NPI:1497180467
Name:GOMEZ, ANDRIA MARIA
Entity Type:Individual
Prefix:
First Name:ANDRIA
Middle Name:MARIA
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 1:21500 PIONEER BLVD STE 105
Mailing Address - Street 2:
Mailing Address - City:HAWAIIAN GARDENS
Mailing Address - State:CA
Mailing Address - Zip Code:90716-2600
Mailing Address - Country:US
Mailing Address - Phone:714-503-6850
Mailing Address - Fax:562-809-3948
Practice Address - Street 1:21500 PIONEER BLVD STE 105
Practice Address - Street 2:
Practice Address - City:HAWAIIAN GARDENS
Practice Address - State:CA
Practice Address - Zip Code:90716-2600
Practice Address - Country:US
Practice Address - Phone:714-503-6850
Practice Address - Fax:562-809-3948
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-10
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37075167G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes167G00000XNursing Service ProvidersLicensed Psychiatric Technician