Healthcare Provider Details

I. General information

NPI: 1841964483
Provider Name (Legal Business Name): ERIKA ESMERALDA GOMEZ PUENTES CARE MANAGER I
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2021
Last Update Date: 05/05/2025
Certification Date: 05/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

169 MASON ST STE 300
UKIAH CA
95482-4483
US

IV. Provider business mailing address

169 MASON ST STE 300
UKIAH CA
95482-4483
US

V. Phone/Fax

Practice location:
  • Phone: 707-463-3300
  • Fax: 707-463-3318
Mailing address:
  • Phone: 707-463-3300
  • Fax: 707-463-3318

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberAMFT154723
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: