Healthcare Provider Details

I. General information

NPI: 1932069556
Provider Name (Legal Business Name): ELIZABETH GOMEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4923 DENNY AVE
NORTH HOLLYWOOD CA
91601-4738
US

IV. Provider business mailing address

4923 DENNY AVE
NORTH HOLLYWOOD CA
91601-4738
US

V. Phone/Fax

Practice location:
  • Phone: 213-910-2629
  • Fax:
Mailing address:
  • Phone: 213-910-2629
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number135475
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: