Provider Demographics
NPI:1235732397
Name:SIA, GOMELIA (NP)
Entity Type:Individual
Prefix:
First Name:GOMELIA
Middle Name:
Last Name:SIA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 S FREMONT AVE
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-3023
Mailing Address - Country:US
Mailing Address - Phone:626-318-7890
Mailing Address - Fax:
Practice Address - Street 1:1510 S CENTRAL AVE STE 510
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91204-2543
Practice Address - Country:US
Practice Address - Phone:818-502-2181
Practice Address - Fax:818-502-2191
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-19
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23037363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily