Provider Demographics
NPI:1831271790
Name:GOMEZ, ESTEBAN MANUEL I (MD)
Entity type:Individual
Prefix:DR
First Name:ESTEBAN
Middle Name:MANUEL
Last Name:GOMEZ
Suffix:I
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5101 FLORENCE AVE
Mailing Address - Street 2:SUITE 7
Mailing Address - City:BELL
Mailing Address - State:CA
Mailing Address - Zip Code:90201
Mailing Address - Country:US
Mailing Address - Phone:323-562-1217
Mailing Address - Fax:323-562-1925
Practice Address - Street 1:5101 FLORENCE AVE
Practice Address - Street 2:SUITE 7
Practice Address - City:BELL
Practice Address - State:CA
Practice Address - Zip Code:90201
Practice Address - Country:US
Practice Address - Phone:323-562-1217
Practice Address - Fax:323-562-1925
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA40128208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB50424Medicare UPIN
CA00A40128Medicare ID - Type Unspecified