Basic Information
| Provider Information | |||||||||
| NPI: | 1023527900 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GOMEZ | ||||||||
| FirstName: | MARIA | ||||||||
| MiddleName: | ALEJANDRA | ||||||||
| NamePrefix: | MS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 23504 LYONS AVE STE 304A | ||||||||
| Address2: | |||||||||
| City: | NEWHALL | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913215776 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6617020166 | ||||||||
| FaxNumber: | 6617020169 | ||||||||
| Practice Location | |||||||||
| Address1: | 23504 LYONS AVE STE 304A | ||||||||
| Address2: | |||||||||
| City: | NEWHALL | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913215776 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6617020166 | ||||||||
| FaxNumber: | 6617020169 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/24/2017 | ||||||||
| LastUpdateDate: | 09/24/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | 1-17-27567 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.