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General NPI Number Information
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NPI Number | 1841024569
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Entity Type | Individual
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Provider Name | ELIZABETH GOMEZ
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Gender | Female
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Dates
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Enumeration Date | 08/27/2024
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Last Update Date | 08/30/2024
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Provider Practice Location Address
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Address Line | 1650 E 4TH ST STE 101
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City | SANTA ANA
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State | CA
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Zip | 92701-5159
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Country | US
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Telephone | 714-667-5220
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Fax |
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Provider Business Mailing Address
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Address Line | 23986 ALISO CREEK RD # 355
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City | LAGUNA NIGUEL
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State | CA
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Zip | 92677-3908
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Country | US
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Telephone |
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 146046
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License Number State | CA
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