Provider Demographics
NPI:1366031437
Name:GOMEZ, GISELL YARELI
Entity type:Individual
Prefix:
First Name:GISELL
Middle Name:YARELI
Last Name: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 1:220 S INDIAN HILL BLVD STE D
Mailing Address - Street 2:
Mailing Address - City:CLAREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:91711-4929
Mailing Address - Country:US
Mailing Address - Phone:626-634-2419
Mailing Address - Fax:
Practice Address - Street 1:220 S INDIAN HILL BLVD STE D
Practice Address - Street 2:
Practice Address - City:CLAREMONT
Practice Address - State:CA
Practice Address - Zip Code:91711-4929
Practice Address - Country:US
Practice Address - Phone:626-634-2419
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-13
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical