Healthcare Provider Details

I. General information

NPI: 1790041804
Provider Name (Legal Business Name): JESSICA GOMEZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2012
Last Update Date: 03/19/2025
Certification Date: 03/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41900 WINCHESTER RD STE 201
TEMECULA CA
92590-3426
US

IV. Provider business mailing address

41900 WINCHESTER RD STE 201
TEMECULA CA
92590-3426
US

V. Phone/Fax

Practice location:
  • Phone: 951-679-0400
  • Fax:
Mailing address:
  • Phone: 951-679-0400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberA154766
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: