Provider Demographics
NPI:1588257489
Name:GOMEZ, TANIA PAOLA (MASTER'S CERTIFICATE)
Entity type:Individual
Prefix:
First Name:TANIA
Middle Name:PAOLA
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:MASTER'S CERTIFICATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 GARDEN VIEW RD
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-1363
Mailing Address - Country:US
Mailing Address - Phone:760-815-3460
Mailing Address - Fax:
Practice Address - Street 1:2350 BUHNE STREET
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501
Practice Address - Country:US
Practice Address - Phone:707-443-4593
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-11
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA123378101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health