Provider Demographics
NPI:1194837146
Name:GOMEZ, SYLVIA J (NMW RN)
Entity Type:Individual
Prefix:
First Name:SYLVIA
Middle Name:J
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:NMW RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:765 MEDICAL CENTER CT STE 209
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91911-6600
Mailing Address - Country:US
Mailing Address - Phone:619-427-8892
Mailing Address - Fax:619-422-7660
Practice Address - Street 1:4004 BEYER BLVD
Practice Address - Street 2:
Practice Address - City:SAN YSIDRO
Practice Address - State:CA
Practice Address - Zip Code:92173-2007
Practice Address - Country:US
Practice Address - Phone:619-428-4463
Practice Address - Fax:619-428-2625
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1570367A00000X
CA402986163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
FHC18880FOtherMEDI-CAL
FHC18880FOtherMEDI-CAL
Q41180Medicare UPIN