MEDICARE: ERICA GOMEZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor
2	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1306170733
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERICA GOMEZ

Provider Business Mailing Address
First Line	:	9044 CANFORD ST
Second Line	:
City	:	PICO RIVERA
State	:	CA
Zip	:	90660-3805
Country	:	US
Telephone Number	:	562-480-2487
Fax Number	:

Provider Business Practice Location Address
First Line	:	441 BAUCHET ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90012-2906
Country	:	US
Telephone Number	:	213-893-5465
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/02/2009
Last Update Date	:	06/21/2021

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