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NPI Code Detail

MEDICARE: MS. ERICA OLYMPIA GOMEZ PA-C

MEDICARE:  MS. ERICA OLYMPIA GOMEZ  PA-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
1363A00000XPhysician AssistantPA19481CA

General Provider Information

NPI Number : 1699959445
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. ERICA OLYMPIA GOMEZ PA-C
Provider Business Mailing Address
First Line : 18335 E VALLEY BLVD
Second Line :
City : LA PUENTE
State : CA
Zip : 91744-5968
Country : US
Telephone Number : 626-810-3330
Fax Number : 626-964-0440
Provider Business Practice Location Address
First Line : 18335 E VALLEY BLVD
Second Line :
City : LA PUENTE
State : CA
Zip : 91744-5968
Country : US
Telephone Number : 626-810-3330
Fax Number : 626-964-0440
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/28/2007
Last Update Date : 12/02/2021

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Directions to “ MS. ERICA OLYMPIA GOMEZ PA-C” Practice Location

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