MEDICARE: GARY RONALD GOMEZ GARCIA FNP-C

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	NP95033220	CA

General Provider Information

NPI Number	:	1386452084
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GARY RONALD GOMEZ GARCIA FNP-C

Provider Business Mailing Address
First Line	:	392 E STEVENS RD APT G15
Second Line	:
City	:	PALM SPRINGS
State	:	CA
Zip	:	92262-4749
Country	:	US
Telephone Number	:	760-673-6559
Fax Number	:

Provider Business Practice Location Address
First Line	:	392 E STEVENS RD APT G15
Second Line	:
City	:	PALM SPRINGS
State	:	CA
Zip	:	92262-4749
Country	:	US
Telephone Number	:	760-673-6559
Fax Number	:

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

Provider Enumeration Date	:	12/27/2024
Last Update Date	:	12/27/2024

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