Provider Demographics
NPI:1891001517
Name:GOMEZ, MAGDA
Entity Type:Individual
Prefix:
First Name:MAGDA
Middle Name:
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 E 4TH ST STE 310
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-3918
Mailing Address - Country:US
Mailing Address - Phone:714-362-3190
Mailing Address - Fax:714-352-3196
Practice Address - Street 1:1901 E 4TH ST STE 310
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-3918
Practice Address - Country:US
Practice Address - Phone:714-362-3190
Practice Address - Fax:714-352-3196
Is Sole Proprietor?:No
Enumeration Date:2010-08-19
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator