Provider Demographics
NPI:1275836249
Name:GOMEZ, LUISANA (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:
First Name:LUISANA
Middle Name:
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:629 W VERMONT AVE
Mailing Address - Street 2:APT 14B
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92805-5054
Mailing Address - Country:US
Mailing Address - Phone:951-367-9631
Mailing Address - Fax:
Practice Address - Street 1:941 S ATLANTIC BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91754-4722
Practice Address - Country:US
Practice Address - Phone:626-458-8401
Practice Address - Fax:626-458-5606
Is Sole Proprietor?:No
Enumeration Date:2010-12-14
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPA20958363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical