Healthcare Provider Details

I. General information

NPI: 1033601661
Provider Name (Legal Business Name): IRENE GOMEZ DRYE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: IRENE ISLAS GOMEZ

II. Dates (important events)

Enumeration Date: 05/30/2018
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 W I ST
BRAWLEY CA
92227-2364
US

IV. Provider business mailing address

PO BOX 287
BRAWLEY CA
92227-0287
US

V. Phone/Fax

Practice location:
  • Phone: 442-442-0615
  • Fax:
Mailing address:
  • Phone: 760-996-5465
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number159666
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number159666
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: