Healthcare Provider Details

I. General information

NPI: 1073433942
Provider Name (Legal Business Name): SAMANTHA LIZETH GOMEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6950 65TH ST
SACRAMENTO CA
95823-2316
US

IV. Provider business mailing address

6950 65TH ST
SACRAMENTO CA
95823-2316
US

V. Phone/Fax

Practice location:
  • Phone: 916-393-1222
  • Fax: 916-393-4512
Mailing address:
  • Phone: 916-393-1222
  • Fax: 916-393-4512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number20720
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: