Provider Demographics
NPI:1356303903
Name:MARIA REMEDIOS R. GOPEZ, MD., INC.
Entity Type:Organization
Organization Name:MARIA REMEDIOS R. GOPEZ, MD., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:REMEDIOS R
Authorized Official - Last Name:GOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-347-1615
Mailing Address - Street 1:81767 DOCTOR CARREON BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92201-5597
Mailing Address - Country:US
Mailing Address - Phone:760-347-1615
Mailing Address - Fax:760-347-1635
Practice Address - Street 1:81767 DOCTOR CARREON BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92201-5597
Practice Address - Country:US
Practice Address - Phone:760-347-1615
Practice Address - Fax:760-347-1635
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-06
Last Update Date:2009-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA731040261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A731040Medicaid