Provider Demographics
NPI:1578198735
Name:MURIEL GOMEZ, JAIRA ANDREA (PA-C)
Entity Type:Individual
Prefix:
First Name:JAIRA
Middle Name:ANDREA
Last Name:MURIEL GOMEZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JAIRA
Other - Middle Name:ANDREA
Other - Last Name:MURIEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:1040 FLYNN RD
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93012-5092
Mailing Address - Country:US
Mailing Address - Phone:805-673-3930
Mailing Address - Fax:805-659-3217
Practice Address - Street 1:650 META ST
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93030-7182
Practice Address - Country:US
Practice Address - Phone:805-487-5351
Practice Address - Fax:805-487-2599
Is Sole Proprietor?:No
Enumeration Date:2020-03-09
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA58352363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant