Provider Demographics
NPI:1164718128
Name:GOMEZ, ANA VICTORIA
Entity Type:Individual
Prefix:
First Name:ANA
Middle Name:VICTORIA
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38021 LIDO DR.
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93552
Mailing Address - Country:US
Mailing Address - Phone:661-341-0116
Mailing Address - Fax:661-285-7360
Practice Address - Street 1:38021 LIDO DR.
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93552
Practice Address - Country:US
Practice Address - Phone:661-341-0116
Practice Address - Fax:661-285-7360
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-28
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA7095009172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver