Healthcare Provider Details

I. General information

NPI: 1699052373
Provider Name (Legal Business Name): ANGELICA ESMERALDA GOMEZ MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2011
Last Update Date: 11/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

162 E CARSON ST
COLUSA CA
95932-2880
US

IV. Provider business mailing address

162 E CARSON ST
COLUSA CA
95932-2880
US

V. Phone/Fax

Practice location:
  • Phone: 530-662-2211
  • Fax: 530-662-4315
Mailing address:
  • Phone: 530-458-0543
  • Fax: 530-458-7171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: