MEDICARE: ALEXIS GOMEZ REGISTERED NURSE PRACTITIONER A PROFESSIONAL CORPORATION

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1780442699
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALEXIS GOMEZ REGISTERED NURSE PRACTITIONER A PROFESSIONAL CORPORATION

Provider Business Mailing Address
First Line	:	6059 FALLBROOK AVE
Second Line	:
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91367-3224
Country	:	US
Telephone Number	:	818-235-3926
Fax Number	:	305-257-9978

Provider Business Practice Location Address
First Line	:	3030 E. 4TH STREET
Second Line	:	SUITE B
City	:	LOS ANGELES
State	:	CA
Zip	:	90063-3137
Country	:	US
Telephone Number	:	818-235-3926
Fax Number	:	305-257-9978

Authorized Official
Title or Position	:	OWNER
Name	:	ALEXIS GOMEZ GONZALEZ
Credential	:	NURSE PRACTITIONER
Telephone Number	:	818-235-3926

Provider Enumeration Date	:	03/06/2024
Last Update Date	:	02/03/2026

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