MEDICARE: GABRIELA 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	104100000X	Social Worker

General Provider Information

NPI Number	:	1780710079
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GABRIELA GOMEZ

Provider Business Mailing Address
First Line	:	4499 MERCURY AVE
Second Line	:	APT. # 25
City	:	LOS ANGELES
State	:	CA
Zip	:	90032-1831
Country	:	US
Telephone Number	:	323-999-2404
Fax Number	:	323-999-2414

Provider Business Practice Location Address
First Line	:	4499 MERCURY AVE
Second Line	:	APT #25
City	:	LOS ANGELES
State	:	CA
Zip	:	90032-1831
Country	:	US
Telephone Number	:	323-999-2404
Fax Number	:	323-999-2414

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

Provider Enumeration Date	:	02/23/2007
Last Update Date	:	07/08/2007

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