Provider Demographics
NPI:1497361877
Name:GARCIA-GOMEZ, AMAPOLA
Entity Type:Individual
Prefix:
First Name:AMAPOLA
Middle Name:
Last Name:GARCIA-GOMEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AMAPOLA
Other - Middle Name:
Other - Last Name:GARCIA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1903 E BAYSHORE RD SPC 16
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94063-4133
Mailing Address - Country:US
Mailing Address - Phone:323-509-9822
Mailing Address - Fax:
Practice Address - Street 1:1001 SNEATH LN STE 200
Practice Address - Street 2:
Practice Address - City:SAN BRUNO
Practice Address - State:CA
Practice Address - Zip Code:94066-2349
Practice Address - Country:US
Practice Address - Phone:650-243-9849
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-21
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician