Provider Demographics
NPI:1497910137
Name:YOLANDA P. GOMEZ, M.D., INC.
Entity Type:Organization
Organization Name:YOLANDA P. GOMEZ, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:YOLANDA
Authorized Official - Middle Name:PATRICIA
Authorized Official - Last Name:GOMEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-713-9705
Mailing Address - Street 1:29941 AVENTURA
Mailing Address - Street 2:SUITE G
Mailing Address - City:RANCHO SANTA MARGARITA
Mailing Address - State:CA
Mailing Address - Zip Code:92688-2015
Mailing Address - Country:US
Mailing Address - Phone:949-713-9705
Mailing Address - Fax:
Practice Address - Street 1:29941 AVENTURA
Practice Address - Street 2:SUITE G
Practice Address - City:RANCHO SANTA MARGARITA
Practice Address - State:CA
Practice Address - Zip Code:92688-2015
Practice Address - Country:US
Practice Address - Phone:949-713-9705
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-22
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC50624261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA000G41V39Medicare PIN
VAC84110Medicare UPIN