Provider Demographics
NPI:1285196949
Name:WINGSHAN LO-GOMEZ DO INC
Entity Type:Organization
Organization Name:WINGSHAN LO-GOMEZ DO INC
Other - Org Name:GLO HEALTH DO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:WINGSHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LO-GOMEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:424-218-6015
Mailing Address - Street 1:2900 BRISTOL ST STE C101
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-5943
Mailing Address - Country:US
Mailing Address - Phone:424-218-6015
Mailing Address - Fax:
Practice Address - Street 1:2900 BRISTOL ST STE C101
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-5943
Practice Address - Country:US
Practice Address - Phone:424-218-6015
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-02
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty