Healthcare Provider Details

I. General information

NPI: 1871777276
Provider Name (Legal Business Name): ANGEL GOMEZ GARCIA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/20/2007
Last Update Date: 12/28/2022
Certification Date: 12/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3531 FEDERAL AVE
LOS ANGELES CA
90066-2810
US

IV. Provider business mailing address

3531 FEDERAL AVE
LOS ANGELES CA
90066-2810
US

V. Phone/Fax

Practice location:
  • Phone: 949-343-4911
  • Fax: 714-771-8481
Mailing address:
  • Phone: 949-343-4911
  • Fax: 714-771-8481

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberA052635
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: