Provider Demographics
NPI:1881370641
Name:GOMEZ HORTA, ANGELICA GUADALUPE
Entity type:Individual
Prefix:
First Name:ANGELICA
Middle Name:GUADALUPE
Last Name:GOMEZ HORTA
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 1:3823 131ST STREET CT NW
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98332-6870
Mailing Address - Country:US
Mailing Address - Phone:907-821-0411
Mailing Address - Fax:
Practice Address - Street 1:3823 131ST STREET CT NW
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98332-6870
Practice Address - Country:US
Practice Address - Phone:907-821-0411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-26
Last Update Date:2024-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling