MEDICARE: COURTNEY GOMEZ

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	363L00000X	Nurse Practitioner	95020581	CA

General Provider Information

NPI Number	:	1588384325
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COURTNEY GOMEZ

Provider Business Mailing Address
First Line	:	1782 NARANCA AVE
Second Line	:
City	:	EL CAJON
State	:	CA
Zip	:	92019-1064
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5333 MISSION CENTER RD STE 210
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-1348
Country	:	US
Telephone Number	:	858-277-2161
Fax Number	:

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

Provider Enumeration Date	:	08/31/2022
Last Update Date	:	09/01/2023

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Directions to “ COURTNEY GOMEZ ” Practice Location

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