1629525068 NPI number — CRISTINA GOMEZ MS

Table of content: CRISTINA GOMEZ MS (NPI 1629525068)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629525068 NPI number — CRISTINA GOMEZ MS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GOMEZ
Provider First Name:
CRISTINA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MS
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:
1629525068
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/17/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10929 SOUTH ST., SUITE 208B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CERRITOS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90703
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
562-924-5526
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10929 SOUTH ST STE 208B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CERRITOS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90703-5368
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-924-5526
Provider Business Practice Location Address Fax Number:
562-924-1040
Provider Enumeration Date:
09/01/2016

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: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 106H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com