Provider Demographics
NPI:1538137898
Name:GOMEZ, GUILLERMO JAVIER (MD)
Entity Type:Individual
Prefix:
First Name:GUILLERMO
Middle Name:JAVIER
Last Name:GOMEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3750 ARLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-2607
Mailing Address - Country:US
Mailing Address - Phone:951-774-3050
Mailing Address - Fax:951-774-3182
Practice Address - Street 1:3750 ARLINGTON AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-2607
Practice Address - Country:US
Practice Address - Phone:951-774-3050
Practice Address - Fax:951-774-3182
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-10
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA69815207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA69815OtherCALIFORNIA LICENCE
CA00A698151Medicaid
CA1346474723OtherNPI NUMBER
WABG6199702OtherDEA
CAZZZ01417ZMedicare ID - Type UnspecifiedGROUP ID
CA1346474723OtherNPI NUMBER