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Provider Information for 1932710647

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

MRS. ALLYCE CHRISTINE GOMEZ MS

Other Name:   ALLYCE CARNERO
Gender: FEMALE

Individual NPI: 1932710647

Calendar   Last Updated:  2020-10-14
  Certification Date:  2020-10-14

Details

Name Value
NPI 1932710647
Enumeration Date 2020-08-14
NPI Type 1 - Individual
Sole Proprietor YES
Status Active
Mailing Address 2644 30TH ST STE 100
SANTA MONICA, CA 90405-3051
United States

Phone: 310-314-6200 | Fax: 301-450-2024
View Map External Link
Primary Practice Address 812 N EUCLID AVE
ONTARIO, CA 91762-2714
United States

Phone: 909-395-0888 | 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 101YM0800X - Counselor Mental Health CA 8584
No 101Y00000X - Counselor