MEDICARE: MARGARETH Y GOMEZ NOJ

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	106H00000X	Marriage & Family Therapist	129190	CA

General Provider Information

NPI Number	:	1891185419
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARGARETH Y GOMEZ NOJ

Provider Business Mailing Address
First Line	:	1605 W OLYMPIC BLVD STE 1035
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90015-3864
Country	:	US
Telephone Number	:	323-898-3414
Fax Number	:

Provider Business Practice Location Address
First Line	:	1605 W OLYMPIC BLVD STE 1035
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90015-3864
Country	:	US
Telephone Number	:	323-898-3414
Fax Number	:

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

Provider Enumeration Date	:	02/03/2015
Last Update Date	:	01/25/2022

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