Provider Demographics
NPI:1558181198
Name:GOMEZ, ANNA BERRIS (MA)
Entity type:Individual
Prefix:MS
First Name:ANNA
Middle Name:BERRIS
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MS
Other - First Name:ANASTASIA
Other - Middle Name:
Other - Last Name:BERRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:13223 BLACK MOUNTAIN RD # 1508
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92129-2698
Mailing Address - Country:US
Mailing Address - Phone:209-596-2599
Mailing Address - Fax:
Practice Address - Street 1:13223 BLACK MOUNTAIN RD # 1508
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92129-2698
Practice Address - Country:US
Practice Address - Phone:209-596-2599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-16
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
CA7220235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7220OtherCALIFORNIA SPEECH LANGUAGE ASSOCIATION