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NPI Code Detail

MEDICARE: GREGORY GOMEZ II

MEDICARE: GREGORY GOMEZ II
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
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1659771467
Entity Type Code : Individual
Provider Name (Legal Business Name) : GREGORY GOMEZ II
Provider Business Mailing Address
First Line : 3021 S HACIENDA BLVD
Second Line :
City : HACIENDA HEIGHTS
State : CA
Zip : 91745-5331
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3021 S HACIENDA BLVD
Second Line :
City : HACIENDA HEIGHTS
State : CA
Zip : 91745-5331
Country : US
Telephone Number : 626-290-4052
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/28/2014
Last Update Date : 10/14/2014

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