1285708594 NPI number — DR. MICHELE A. GOMEZ MD

Table of content: DR. MICHELE A. GOMEZ MD (NPI 1285708594)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285708594 NPI number — DR. MICHELE A. GOMEZ MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GOMEZ
Provider First Name:
MICHELE
Provider Middle Name:
A.
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1285708594
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/04/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1720 EL CAMINO REAL
Provider Second Line Business Mailing Address:
STE. #165
Provider Business Mailing Address City Name:
BURLINGAME
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94010-3224
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
650-692-0977
Provider Business Mailing Address Fax Number:
650-259-5840

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1720 EL CAMINO REAL
Provider Second Line Business Practice Location Address:
STE. #165
Provider Business Practice Location Address City Name:
BURLINGAME
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94010-3224
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
650-692-0977
Provider Business Practice Location Address Fax Number:
650-259-5840
Provider Enumeration Date:
11/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  A77883 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00A778830 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: A77883 . This is a "MEDICAL BOARD OF CALIFORNIA LICENSE NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 207Q00000X . This is a "MEDICARE NPI TAXONOMY" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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