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NPI Code Detail

MEDICARE: MARIA CARLA GONG NP

MEDICARE: MARIA CARLA GONG NP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician95016747CA
2363LF0000XFamily Nurse Practitioner95016747CA

General Provider Information

NPI Number : 1043895956
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARIA CARLA GONG NP
Provider Business Mailing Address
First Line : PO BOX 35380
Second Line :
City : LAS VEGAS
State : NV
Zip : 89133-5380
Country : US
Telephone Number : 702-579-3203
Fax Number :
Provider Business Practice Location Address
First Line : 8311 FLORENCE AVE
Second Line :
City : DOWNEY
State : CA
Zip : 90240-3928
Country : US
Telephone Number : 702-579-3203
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/11/2021
Last Update Date : 05/13/2026

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