Provider Demographics
NPI:1912181876
Name:GOMEZ, JOSE ANGEL (MFT INTERN)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:ANGEL
Last Name:GOMEZ
Suffix:
Gender:M
Credentials:MFT INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26569 PEACHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92563-6355
Mailing Address - Country:US
Mailing Address - Phone:951-553-4197
Mailing Address - Fax:
Practice Address - Street 1:1200 N MAIN ST STE 100B
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701-3630
Practice Address - Country:US
Practice Address - Phone:714-480-6650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-27
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMFT116713106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist