Healthcare Provider Details

I. General information

NPI: 1932710647
Provider Name (Legal Business Name): ALLYCE CHRISTINE GOMEZ MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ALLYCE CHRISTINE CARNERO BS

II. Dates (important events)

Enumeration Date: 08/14/2020
Last Update Date: 01/03/2025
Certification Date: 01/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5201 GREAT AMERICA PKWY STE 320
SANTA CLARA CA
95054-1140
US

IV. Provider business mailing address

5201 GREAT AMERICA PKWY STE 320
SANTA CLARA CA
95054-1140
US

V. Phone/Fax

Practice location:
  • Phone: 323-205-7088
  • Fax:
Mailing address:
  • Phone:
  • Fax: 301-450-2024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number18014
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: