Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | G68196 | CA |
NPI | 1033129028 |
---|---|
Provider Name | Robert Alan Gomez |
First Address | Alamo, CA 94507 |
Second Address | Vallejo, CA 94589-2567 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2006 |
Last Update Date | 29/10/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F96356 | (02) |