MEDICARE: ANA CAMILA GOMEZ FNP-BC

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
1	363LF0000X	Family Nurse Practitioner	95004114	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	95004114	OTHER	CA	CALIFORNIA BOARD OF REGISTERED NURSING NP LICENSE #

General Provider Information

NPI Number	:	1184071631
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANA CAMILA GOMEZ FNP-BC

Provider Business Mailing Address
First Line	:	908 W 15TH AVE
Second Line	:
City	:	ESCONDIDO
State	:	CA
Zip	:	92025-5544
Country	:	US
Telephone Number	:	951-760-2173
Fax Number	:

Provider Business Practice Location Address
First Line	:	318 W EL NORTE PKWY
Second Line	:
City	:	ESCONDIDO
State	:	CA
Zip	:	92026-1925
Country	:	US
Telephone Number	:	866-389-2727
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/14/2016
Last Update Date	:	12/08/2021

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