1467164673 NPI number — YESICA G GAMEZ CRUZ I

Table of content: YESICA G GAMEZ CRUZ I (NPI 1467164673)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467164673 NPI number — YESICA G GAMEZ CRUZ I

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GAMEZ CRUZ
Provider First Name:
YESICA
Provider Middle Name:
G
Provider Name Prefix Text:
Provider Name Suffix Text:
I
Provider Credential Text:
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:
1467164673
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/19/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
DEPT LA 22763, PASADENACA 91185-2763
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PASADENA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91185-2763
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
886-523-4268
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
DEPTLA 22763
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PASADENA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91185-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
866-523-4268
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/19/2022

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: 106S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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