MEDICARE: DR. JAIRO GOMEZ M.D.

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
1	2084P0800X	Psychiatry Physician	C38279	CA

General Provider Information

NPI Number	:	1417055104
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAIRO GOMEZ M.D.

Provider Business Mailing Address
First Line	:	1700 E CESAR CHAVEZ AVE
Second Line	:	STE 3300
City	:	LOS ANGELES
State	:	CA
Zip	:	90033-2424
Country	:	US
Telephone Number	:	323-265-4023
Fax Number	:	323-265-4053

Provider Business Practice Location Address
First Line	:	1700 E CESAR CHAVEZ AVE
Second Line	:	STE 3300
City	:	LOS ANGELES
State	:	CA
Zip	:	90033-2424
Country	:	US
Telephone Number	:	323-265-4023
Fax Number	:	323-265-4053

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	07/09/2007

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Directions to “ DR. JAIRO GOMEZ M.D.” Practice Location

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