Healthcare Provider Details

I. General information

NPI: 1134868813
Provider Name (Legal Business Name): DAPHNE GABRIELA GOMEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2022
Last Update Date: 08/07/2023
Certification Date: 08/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15305 RAYEN ST
NORTH HILLS CA
91343-5117
US

IV. Provider business mailing address

15305 RAYEN ST
NORTH HILLS CA
91343-5117
US

V. Phone/Fax

Practice location:
  • Phone: 818-892-3423
  • Fax: 818-893-4509
Mailing address:
  • Phone: 818-892-3423
  • Fax: 818-893-4509

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberY4693436
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: