Provider Demographics
NPI:1689823262
Name:GOMEZ, CHASKA LATOYA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CHASKA
Middle Name:LATOYA
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:CHASKA
Other - Middle Name:LATOYA
Other - Last Name:BARKSDALE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:216 MERCURY ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96818-5932
Mailing Address - Country:US
Mailing Address - Phone:908-528-3500
Mailing Address - Fax:
Practice Address - Street 1:1 JARRETT WHITE RD
Practice Address - Street 2:
Practice Address - City:TRIPLER ARMY MEDICAL CENTER
Practice Address - State:HI
Practice Address - Zip Code:96859
Practice Address - Country:US
Practice Address - Phone:808-433-2990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-18
Last Update Date:2018-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810004369103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical