Provider Demographics
NPI:1346067972
Name:CARPIO GOMEZ, VERONICA E
Entity type:Individual
Prefix:MISS
First Name:VERONICA
Middle Name:E
Last Name:CARPIO GOMEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5100 HEDRICK AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92505-1365
Mailing Address - Country:US
Mailing Address - Phone:951-999-2052
Mailing Address - Fax:
Practice Address - Street 1:4060 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92501-3537
Practice Address - Country:US
Practice Address - Phone:909-470-1456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-24
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17120101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor