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NPI Code Detail

MEDICARE: RODOLFO MARTIN GOMEZ LMFT

MEDICARE: RODOLFO MARTIN GOMEZ LMFT
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
1106H00000XMarriage & Family TherapistLMFT53751CA

General Provider Information

NPI Number : 1396043329
Entity Type Code : Individual
Provider Name (Legal Business Name) : RODOLFO MARTIN GOMEZ LMFT
Provider Business Mailing Address
First Line : PO BOX 63231
Second Line :
City : IRVINE
State : CA
Zip : 92602-6107
Country : US
Telephone Number : 714-943-6498
Fax Number :
Provider Business Practice Location Address
First Line : 600 W SANTA ANA BLVD STE 600
Second Line :
City : SANTA ANA
State : CA
Zip : 92701-4552
Country : US
Telephone Number : 714-953-4455
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/28/2011
Last Update Date : 05/24/2024

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