Healthcare Provider Details

I. General information

NPI: 1184840829
Provider Name (Legal Business Name): MRS. MARITZA GOMEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARITZA GOMEZ

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16644 RINALDI ST
GRANADA HILLS CA
91344-3631
US

IV. Provider business mailing address

7720 NE HIGHWAY 99 STE D
VANCOUVER WA
98665-8859
US

V. Phone/Fax

Practice location:
  • Phone: 831-420-7283
  • Fax:
Mailing address:
  • Phone: 360-610-7142
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number109685
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number60914013
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: