Individual
BRYAN GOMEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
XXX34392
Contact information
Practice address
1172 SOUTH GRAND AVE, GLENDORA, CA 91740
(626) 335-5980
Mailing address
4122 LINCOLN AVE., EL MONTE, CA 91731-2108
(626) 454-2205
Taxonomy
Speciality
Code
Description
License number
State
167G00000X
Licensed Psychiatric Technician
Primary
34392
CA
Other
Enumeration date
10/07/2008
Last updated
10/07/2008
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