Provider Demographics
NPI:1851188908
Name:GOMEZ, LAURA ANAHI
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:ANAHI
Last Name:GOMEZ
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:ANAHI
Other - Last Name:MEJIA CHI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:750 E PIONEER AVE
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92374-1753
Mailing Address - Country:US
Mailing Address - Phone:909-242-2333
Mailing Address - Fax:
Practice Address - Street 1:670 W LAUREL ST
Practice Address - Street 2:
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-1523
Practice Address - Country:US
Practice Address - Phone:909-580-5009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-22
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1232351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical