Healthcare Provider Details

I. General information

NPI: 1770034324
Provider Name (Legal Business Name): MAGDALENA GOMEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2016
Last Update Date: 09/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14125 GARFIELD AVE
PARAMOUNT CA
90723
US

IV. Provider business mailing address

2039 E WALNUT CREEK PARKWAY
WEST COVINA CA
91791
US

V. Phone/Fax

Practice location:
  • Phone: 877-692-7471
  • Fax:
Mailing address:
  • Phone: 323-506-7058
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code343800000X
TaxonomySecured Medical Transport (VAN)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: