Provider Demographics
NPI:1376769828
Name:GARCIA DE GOMEZ, VERENICE G (CLINICAL PSYCH BS)
Entity type:Individual
Prefix:MRS
First Name:VERENICE
Middle Name:G
Last Name:GARCIA DE GOMEZ
Suffix:
Gender:F
Credentials:CLINICAL PSYCH BS
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Mailing Address - Street 1:5805 SEPULVEDA BLVD STE 710
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91411-2522
Mailing Address - Country:US
Mailing Address - Phone:818-980-3200
Mailing Address - Fax:
Practice Address - Street 1:5805 SEPULVEDA BLVD STE 710
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91411-2522
Practice Address - Country:US
Practice Address - Phone:818-980-3200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2024-06-10
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner