Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2086S0129X | Vascular Surgeon | A33949 | CA |
Y | 208G00000X | Cardiothoracic Vascular Surgeon | A33949 | CA |
NPI | 1144508995 |
---|---|
Provider Name | Hugo Edgardo Gomez-Engler |
First Address | La Mesa, CA 91942-3009 |
Second Address | La Mesa, CA 91942-3009 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2011 |
Last Update Date | 19/12/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
GW765A | MEDICARE PTAN (01) | CA |