Healthcare Provider Details

I. General information

NPI: 1275789703
Provider Name (Legal Business Name): FRANCISCO GOMEZ PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2008
Last Update Date: 08/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 W. WASHINGTON ST. STE. 2, #117
SAN DIEGO CA
92103
US

IV. Provider business mailing address

325 W. WASHINGTON ST. STE. 2, #117
SAN DIEGO CA
92103
US

V. Phone/Fax

Practice location:
  • Phone: 619-518-4045
  • Fax: 619-923-0000
Mailing address:
  • Phone: 619-518-4045
  • Fax: 619-923-0000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number15682
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: