Provider Demographics
NPI:1952774432
Name:LAUREL GOMEZ, KORINA
Entity Type:Individual
Prefix:
First Name:KORINA
Middle Name:
Last Name:LAUREL 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 1:777 NORTH FIRST STREET
Mailing Address - Street 2:SUITE 444
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95112
Mailing Address - Country:US
Mailing Address - Phone:408-240-0070
Mailing Address - Fax:
Practice Address - Street 1:777 N 1ST ST
Practice Address - Street 2:SUITE 444
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95112-6337
Practice Address - Country:US
Practice Address - Phone:408-240-0070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-05
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAF7052656101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor