Provider Demographics
NPI:1508498973
Name:GOMEZ, ROSIE LETICIA
Entity Type:Individual
Prefix:
First Name:ROSIE
Middle Name:LETICIA
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 1:508 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:SAN BRUNO
Mailing Address - State:CA
Mailing Address - Zip Code:94066-4522
Mailing Address - Country:US
Mailing Address - Phone:650-771-7701
Mailing Address - Fax:650-634-8717
Practice Address - Street 1:508 7TH AVE
Practice Address - Street 2:
Practice Address - City:SAN BRUNO
Practice Address - State:CA
Practice Address - Zip Code:94066-4522
Practice Address - Country:US
Practice Address - Phone:650-771-7701
Practice Address - Fax:650-634-8717
Is Sole Proprietor?:No
Enumeration Date:2020-02-04
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor