Healthcare Provider Details

I. General information

NPI: 1134961832
Provider Name (Legal Business Name): BIBIANA SARAHI GOMEZ HIGUERA AMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2024
Last Update Date: 11/10/2025
Certification Date: 11/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1424 30TH ST STE A
SAN DIEGO CA
92154-3417
US

IV. Provider business mailing address

1424 30TH ST STE A
SAN DIEGO CA
92154-3417
US

V. Phone/Fax

Practice location:
  • Phone: 195-652-6506
  • Fax: 619-565-2656
Mailing address:
  • Phone: 619-565-2650
  • Fax: 619-565-2656

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number159151
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: