Individual
MICAELA T GOMEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
1260 7TH ST, LOS BANOS, CA 93635-4337
(209) 826-4981
Mailing address
1717 S 11TH ST, LOS BANOS, CA 93635-4800
(209) 620-0417
Taxonomy
Speciality
Code
Description
License number
State
103TS0200X
School Psychologist
Primary
3142
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3142
BOARD OF BEHAVIORAL SCIENCES
CA
Enumeration date
02/17/2022
Last updated
02/17/2022
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