Healthcare Provider Details

I. General information

NPI: 1366037129
Provider Name (Legal Business Name): ADRIANA GOMEZ-MARTINEZ M.ED.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ADRIANA GOMEZ

II. Dates (important events)

Enumeration Date: 03/04/2021
Last Update Date: 03/04/2021
Certification Date: 03/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1063 MCGAW AVE STE 100
IRVINE CA
92614-5554
US

IV. Provider business mailing address

1032 W 225TH ST
TORRANCE CA
90502-2312
US

V. Phone/Fax

Practice location:
  • Phone: 714-876-1815
  • Fax:
Mailing address:
  • Phone: 310-702-0258
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: