Provider Demographics
NPI:1881015428
Name:VILLAGOMES, GABRIELA (MA)
Entity Type:Individual
Prefix:
First Name:GABRIELA
Middle Name:
Last Name:VILLAGOMES
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:VILLAGOMEZ
Other - Middle Name:
Other - Last Name:GABRIELA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4900 SERRANIA AVE
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-3301
Mailing Address - Country:US
Mailing Address - Phone:818-347-1577
Mailing Address - Fax:
Practice Address - Street 1:4900 SERRANIA AVE
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-3301
Practice Address - Country:US
Practice Address - Phone:818-347-1577
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-28
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA123705106H00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program