Provider Demographics
NPI:1871777276
Name:GARCIA, ANGEL GOMEZ (MD)
Entity type:Individual
Prefix:
First Name:ANGEL
Middle Name:GOMEZ
Last Name:GARCIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3531 FEDERAL AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90066-2810
Mailing Address - Country:US
Mailing Address - Phone:949-343-4911
Mailing Address - Fax:714-771-8481
Practice Address - Street 1:3531 FEDERAL AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90066-2810
Practice Address - Country:US
Practice Address - Phone:949-343-4911
Practice Address - Fax:714-771-8481
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-20
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA052635261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95-4799597OtherTAX ID