Provider Demographics
NPI:1316044282
Name:GOMEZ, ERICA AMBROZEVICIUS (DMSC, MPAP, PA-C)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:AMBROZEVICIUS
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:DMSC, MPAP, PA-C
Other - Prefix:MS
Other - First Name:ERICA
Other - Middle Name:LOPEZ
Other - Last Name:AMBROZEVICIUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2100 SAN JOSE AVE
Mailing Address - Street 2:
Mailing Address - City:LA HABRA
Mailing Address - State:CA
Mailing Address - Zip Code:90631-5035
Mailing Address - Country:US
Mailing Address - Phone:626-383-4264
Mailing Address - Fax:562-451-3026
Practice Address - Street 1:2251 N HARBOR BLVD
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-2601
Practice Address - Country:US
Practice Address - Phone:714-449-6230
Practice Address - Fax:714-449-1773
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA17475363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant