Healthcare Provider Details

I. General information

NPI: 1275904880
Provider Name (Legal Business Name): ANDRY JANINE GOMEZ ALECIO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2015
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2335 PLAZA DEL AMO
TORRANCE CA
90501-3420
US

IV. Provider business mailing address

1476 W 37TH ST
LOS ANGELES CA
90018-4519
US

V. Phone/Fax

Practice location:
  • Phone: 323-383-7501
  • Fax:
Mailing address:
  • Phone: 323-383-7501
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number29574
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: