Provider Demographics
NPI:1699052373
Name:GOMEZ, ANGELICA ESMERALDA (MSW)
Entity type:Individual
Prefix:
First Name:ANGELICA
Middle Name:ESMERALDA
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:162 E CARSON ST
Mailing Address - Street 2:
Mailing Address - City:COLUSA
Mailing Address - State:CA
Mailing Address - Zip Code:95932-2880
Mailing Address - Country:US
Mailing Address - Phone:530-458-0543
Mailing Address - Fax:530-458-7171
Practice Address - Street 1:162 E CARSON ST
Practice Address - Street 2:
Practice Address - City:COLUSA
Practice Address - State:CA
Practice Address - Zip Code:95932-2880
Practice Address - Country:US
Practice Address - Phone:530-662-2211
Practice Address - Fax:530-662-4315
Is Sole Proprietor?:No
Enumeration Date:2011-11-09
Last Update Date:2013-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical