MEDICARE: MR. ALEXIS GOMEZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	172V00000X	Community Health Worker
2	175T00000X	Peer Specialist	CA
3	101Y00000X	Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	95-26337565	OTHER	CA	MEDI-CAL

General Provider Information

NPI Number	:	1720521057
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ALEXIS GOMEZ

Provider Business Mailing Address
First Line	:	12021 WILMINGTON AVE UNIT 2B
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90059-3019
Country	:	US
Telephone Number	:	213-222-1681
Fax Number	:

Provider Business Practice Location Address
First Line	:	12021 WILMINGTON AVE UNIT 2B
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90059-3019
Country	:	US
Telephone Number	:	213-222-1681
Fax Number	:

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

Provider Enumeration Date	:	11/17/2016
Last Update Date	:	03/10/2026

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Directions to “ MR. ALEXIS GOMEZ ” Practice Location

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