Provider Demographics
NPI:1891185419
Name:GOMEZ NOJ, MARGARETH Y
Entity Type:Individual
Prefix:
First Name:MARGARETH
Middle Name:Y
Last Name:GOMEZ NOJ
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 1:1605 W OLYMPIC BLVD STE 1035
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90015-3864
Mailing Address - Country:US
Mailing Address - Phone:323-898-3414
Mailing Address - Fax:
Practice Address - Street 1:1605 W OLYMPIC BLVD STE 1035
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90015-3864
Practice Address - Country:US
Practice Address - Phone:323-898-3414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-03
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA129190106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist