Provider Demographics
NPI:1740798404
Name:GOMEZ CARRANZA, PEDRO (LPCC, MED, MA)
Entity Type:Individual
Prefix:
First Name:PEDRO
Middle Name:
Last Name:GOMEZ CARRANZA
Suffix:
Gender:M
Credentials:LPCC, MED, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:428 FERMOORE ST
Mailing Address - Street 2:
Mailing Address - City:SAN FERNANDO
Mailing Address - State:CA
Mailing Address - Zip Code:91340-2303
Mailing Address - Country:US
Mailing Address - Phone:818-522-7293
Mailing Address - Fax:
Practice Address - Street 1:428 FERMOORE ST
Practice Address - Street 2:
Practice Address - City:SAN FERNANDO
Practice Address - State:CA
Practice Address - Zip Code:91340-2303
Practice Address - Country:US
Practice Address - Phone:818-522-7293
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-16
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CA11045101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health