Provider Demographics
NPI:1790053528
Name:GOMEZ, RICARDO M (MD)
Entity type:Individual
Prefix:
First Name:RICARDO
Middle Name:M
Last Name:GOMEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:18092 WIKA RD STE 220
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92307-2132
Mailing Address - Country:US
Mailing Address - Phone:760-515-6260
Mailing Address - Fax:949-863-8505
Practice Address - Street 1:18012 WIKA RD
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307-2125
Practice Address - Country:US
Practice Address - Phone:442-292-2358
Practice Address - Fax:949-695-4153
Is Sole Proprietor?:No
Enumeration Date:2011-12-07
Last Update Date:2024-05-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY263568-1207R00000X
CAA134736207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine