Provider Demographics
NPI:1174225510
Name:GOMEZ, DIEGO FELIPE (MD)
Entity type:Individual
Prefix:
First Name:DIEGO
Middle Name:FELIPE
Last Name:GOMEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:DIEGO
Other - Middle Name:FELIPE
Other - Last Name:GOMEZ BLANCO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1200 N STATE ST CLINIC TOWER SUITE A7D
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90089-0001
Mailing Address - Country:US
Mailing Address - Phone:323-409-7053
Mailing Address - Fax:
Practice Address - Street 1:1200 N STATE ST CLINIC TOWER SUITE A7D
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90089-0001
Practice Address - Country:US
Practice Address - Phone:323-409-7053
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-20
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program