Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | PT26517 | CA |
NPI | 1861524688 |
---|---|
Provider Name | Beth S Gomez |
First Address | Fountain Valley, CA 92728-8125 |
Second Address | Irvine, CA 92618-3735 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/03/2007 |
Last Update Date | 08/07/2007 |