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General NPI Number Information
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NPI Number | 1528801362
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Entity Type | Individual
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Provider Name | JAZMIN GOMEZ
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Gender | Female
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Dates
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Enumeration Date | 06/18/2024
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Last Update Date | 06/18/2024
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Provider Practice Location Address
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Address Line | 5301 BEETHOVEN ST
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City | LOS ANGELES
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State | CA
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Zip | 90066-7061
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Country | US
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Telephone | 310-821-0963
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Fax |
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Provider Business Mailing Address
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Address Line | 4717 W 111TH ST
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City | INGLEWOOD
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State | CA
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Zip | 90304-2237
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Country | US
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Telephone | 310-978-7715
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 02415253
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License Number State | CA
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