1184302374 NPI number — GOMEZ HEALTH, A PHYSICIAN ASSISTANT CORPORATION

Table of content: (NPI 1184302374)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184302374 NPI number — GOMEZ HEALTH, A PHYSICIAN ASSISTANT CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GOMEZ HEALTH, A PHYSICIAN ASSISTANT CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1184302374
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2100 SAN JOSE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LA HABRA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90631-5035
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
626-383-4264
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1820 W ORANGEWOOD AVE STE 105
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ORANGE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92868-5052
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
657-246-3658
Provider Business Practice Location Address Fax Number:
562-451-3026
Provider Enumeration Date:
07/07/2023

Additional Information

Authorized Official

Authorized Official Last Name:
GOMEZ
Authorized Official First Name:
ERICA
Authorized Official Middle Name:
AMBROZEVICIUS
Authorized Official Title or Position:
OWNER, PRESIDENT
Authorized Official Telephone Number:
657-246-3658

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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