Basic Information
| Provider Information | |||||||||
| NPI: | 1306035704 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GOMEZ CASTILLO | ||||||||
| FirstName: | XAVIER | ||||||||
| MiddleName: | ASTOLFO | ||||||||
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| Credential: | M.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 330 CORDOVA ST UNIT 162 | ||||||||
| Address2: | |||||||||
| City: | PASADENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 911014653 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8185159025 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 66 HURLBUT ST | ||||||||
| Address2: | |||||||||
| City: | PASADENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 911054025 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6264414221 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/22/2007 | ||||||||
| LastUpdateDate: | 03/22/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/22/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 75828 | CA | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 106H00000X | 114440 | CA | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 106H00000X | 75828 | CA | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 101YM0800X | 114440 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.