Provider Demographics
NPI:1881736890
Name:GOMEZ-MORALES, SYLVIA PATRICIA (PHD)
Entity type:Individual
Prefix:DR
First Name:SYLVIA
Middle Name:PATRICIA
Last Name:GOMEZ-MORALES
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MISS
Other - First Name:SYLVIA
Other - Middle Name:PATRICIA
Other - Last Name:GOMEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:9138 MYRON ST
Mailing Address - Street 2:
Mailing Address - City:PICO RIVERA
Mailing Address - State:CA
Mailing Address - Zip Code:90660-5137
Mailing Address - Country:US
Mailing Address - Phone:562-972-9301
Mailing Address - Fax:
Practice Address - Street 1:2050 YOUTH WAY
Practice Address - Street 2:BLDG. #1
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835
Practice Address - Country:US
Practice Address - Phone:714-871-9264
Practice Address - Fax:714-871-5032
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPS2007015103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent