Provider Demographics
NPI:1588484208
Name:GOMEZ, ANNABELLA ROSA
Entity type:Individual
Prefix:
First Name:ANNABELLA
Middle Name:ROSA
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 1:113 CRAWLEY FALLS RD UNIT 1
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:NH
Mailing Address - Zip Code:03833-2126
Mailing Address - Country:US
Mailing Address - Phone:818-292-0645
Mailing Address - Fax:
Practice Address - Street 1:113 CRAWLEY FALLS RD UNIT 1
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:NH
Practice Address - Zip Code:03833-2126
Practice Address - Country:US
Practice Address - Phone:818-292-0645
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-16
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician