| Pink Moon Hc A Licensed Clinical Social Worker Corporation | |
|
341 N Reno St Los Angeles CA 90026-4507 | |
| (213) 703-6234 | |
| Not Available |
| Full Name | Pink Moon Hc A Licensed Clinical Social Worker Corporation |
|---|---|
| Speciality | Public Health or Welfare |
| Location | 341 N Reno St, Los Angeles, California |
| Authorized Official Name and Position | Aubri Gomez (FOUNDER/PSYCHOTHERAPIST) |
| Authorized Official Contact | 2137036234 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Pink Moon Hc A Licensed Clinical Social Worker Corporation 341 N Reno St Los Angeles CA 90026-4507 Ph: (213) 703-6234 | Pink Moon Hc A Licensed Clinical Social Worker Corporation 341 N Reno St Los Angeles CA 90026-4507 Ph: (213) 703-6234 |
| NPI Number | 1659191179 |
|---|---|
| Provider Enumeration Date | 10/10/2024 |
| Last Update Date | 10/10/2024 |
| Certification Date | 10/10/2024 |
| Medicare PECOS PAC ID | 0840720769 |
|---|---|
| Medicare Enrollment ID | O20250208000087 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659191179 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Secondary |
| 251K00000X | Public Health Or Welfare | (* (Not Available)) | Primary |
| Provider Name | Aubri Aubri Gomez |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1356796395 PECOS PAC ID: 2567992480 Enrollment ID: I20250212003669 |
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