Provider Demographics
NPI:1699332965
Name:GOMEZ-VASQUEZ, ALEJANDRA (AMFT)
Entity type:Individual
Prefix:
First Name:ALEJANDRA
Middle Name:
Last Name:GOMEZ-VASQUEZ
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:ALEJANDRA
Other - Middle Name:
Other - Last Name:GOMEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AMFT
Mailing Address - Street 1:1480 LINCOLN AVE STE 8
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-2085
Mailing Address - Country:US
Mailing Address - Phone:415-456-1050
Mailing Address - Fax:
Practice Address - Street 1:3720 SUNSET LN
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94509-6133
Practice Address - Country:US
Practice Address - Phone:925-978-0208
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-22
Last Update Date:2025-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106H00000X, 106H00000X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty