Provider Demographics
NPI:1558762351
Name:GOMEZ, MAYRA RUVALCABA (LCSW)
Entity Type:Individual
Prefix:
First Name:MAYRA
Middle Name:RUVALCABA
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 W LA VETA AVE STE 660
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-4244
Mailing Address - Country:US
Mailing Address - Phone:714-583-6810
Mailing Address - Fax:
Practice Address - Street 1:1120 W LA VETA AVE STE 660
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-4244
Practice Address - Country:US
Practice Address - Phone:714-296-6921
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-11
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW875701041C0700X
1041C0700X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program