Provider Demographics
NPI:1780710079
Name:GOMEZ, GABRIELA
Entity type:Individual
Prefix:
First Name:GABRIELA
Middle Name:
Last Name:GOMEZ
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 1:4499 MERCURY AVE
Mailing Address - Street 2:APT. # 25
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90032-1831
Mailing Address - Country:US
Mailing Address - Phone:323-999-2404
Mailing Address - Fax:323-999-2414
Practice Address - Street 1:4499 MERCURY AVE
Practice Address - Street 2:APT #25
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90032-1831
Practice Address - Country:US
Practice Address - Phone:323-999-2404
Practice Address - Fax:323-999-2414
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker