MEDICARE: MS. CATHARINE A GOMEZ V MFT

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	174400000X	Specialist	33966	CA

General Provider Information

NPI Number	:	1760536437
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CATHARINE A GOMEZ V MFT

Provider Business Mailing Address
First Line	:	333 N LANTANA ST
Second Line	:	SUITE 269
City	:	CAMARILLO
State	:	CA
Zip	:	93010-9010
Country	:	US
Telephone Number	:	805-383-4565
Fax Number	:	805-383-4565

Provider Business Practice Location Address
First Line	:	333 N LANTANA ST
Second Line	:	SUITE 269
City	:	CAMARILLO
State	:	CA
Zip	:	93010-9010
Country	:	US
Telephone Number	:	805-383-4565
Fax Number	:	805-383-4565

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

Provider Enumeration Date	:	01/22/2007
Last Update Date	:	02/22/2025

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