Provider Demographics
NPI:1609824986
Name:GOMEZ, JOSE LUIS (MD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:LUIS
Last Name:GOMEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:9449 E. IMPERIAL HWY
Mailing Address - Street 2:SUITE 142
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90242
Mailing Address - Country:US
Mailing Address - Phone:562-657-4890
Mailing Address - Fax:323-254-2158
Practice Address - Street 1:9449 E. IMPERIAL HWY
Practice Address - Street 2:SUITE 142
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90242
Practice Address - Country:US
Practice Address - Phone:562-657-4890
Practice Address - Fax:323-254-2158
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA87407207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine