Provider Demographics
NPI:1790086858
Name:DANIEL R GOMES, D.P.M., INC.
Entity Type:Organization
Organization Name:DANIEL R GOMES, D.P.M., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:GOMES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:510-794-6699
Mailing Address - Street 1:1800 MOWRY AVE
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-1712
Mailing Address - Country:US
Mailing Address - Phone:510-794-6699
Mailing Address - Fax:510-794-6637
Practice Address - Street 1:1800 MOWRY AVE
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1712
Practice Address - Country:US
Practice Address - Phone:510-794-6699
Practice Address - Fax:510-794-6637
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-05
Last Update Date:2010-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA000E17280213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E17280Medicare PIN