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Provider Information for 1194116400

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know

ALYSSA GOMEZ BCBA

Gender: FEMALE

Individual NPI: 1194116400

Calendar   Last Updated:  2021-01-08
  Certification Date:  2021-01-08

Details

Name Value
NPI 1194116400
Enumeration Date 2015-02-09
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address 16782 VON KARMAN AVE STE 11
IRVINE, CA 92606-2417
United States

Phone: 619-550-6368 | Fax:
View Map External Link
Primary Practice Address 1425 N MCDOWELL BLVD STE 206
PETALUMA, CA 94954-6525
United States

Phone: 855-223-7123 | Fax: 714-784-7516
View Map External Link
Secondary Practice Address 2275 ARLINGTON DR
SAN LEANDRO, CA 94578-1132
United States

Phone: 510-317-1444 | Fax:
View Map External Link

Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 103K00000X - Behavioral Analyst
No 101Y00000X - Counselor