Healthcare Provider Details

I. General information

NPI: 1659804995
Provider Name (Legal Business Name): ALEXANDER GOMEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2017
Last Update Date: 08/12/2021
Certification Date: 08/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4150 CLEMENT ST MAILSTOP 111S
SAN FRANCISCO CA
94121-1563
US

IV. Provider business mailing address

4150 CLEMENT ST MAILSTOP 111S
SAN FRANCISCO CA
94121-1563
US

V. Phone/Fax

Practice location:
  • Phone: 415-221-4810
  • Fax:
Mailing address:
  • Phone: 415-221-4810
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMT214046
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207QS1201X
TaxonomySleep Medicine (Family Medicine) Physician
License NumberA169754
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA169754
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: