Provider Demographics
NPI:1952836025
Name:GOMEZ, ELSA (FNP-C)
Entity Type:Individual
Prefix:
First Name:ELSA
Middle Name:
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4670 GAGE AVE
Mailing Address - Street 2:
Mailing Address - City:BELL GARDENS
Mailing Address - State:CA
Mailing Address - Zip Code:90201-1360
Mailing Address - Country:US
Mailing Address - Phone:323-562-3135
Mailing Address - Fax:323-375-0771
Practice Address - Street 1:4670 GAGE AVE
Practice Address - Street 2:
Practice Address - City:BELL GARDENS
Practice Address - State:CA
Practice Address - Zip Code:90201-1360
Practice Address - Country:US
Practice Address - Phone:323-562-3135
Practice Address - Fax:323-375-0771
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-26
Last Update Date:2017-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95005057363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily