Provider Demographics
NPI:1174670012
Name:GOMEZ, MARIA JOSEPHINA TRAN (FNP)
Entity type:Individual
Prefix:
First Name:MARIA JOSEPHINA
Middle Name:TRAN
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:JOSEPHINA
Other - Middle Name:TRAN
Other - Last Name:GOMEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP
Mailing Address - Street 1:300 PASTEUR DRIVE, STANFORD HOSPITAL AND CLINICS
Mailing Address - Street 2:DIGESTIVE HEALTH CENTER, BLAKE WILBUR BUILDING
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94305
Mailing Address - Country:US
Mailing Address - Phone:650-736-5555
Mailing Address - Fax:650-723-8378
Practice Address - Street 1:300 PASTEUR DRIVE, STANFORD HOSPITAL AND CLINICS
Practice Address - Street 2:DIGESTIVE HEALTH CENTER, BLAKE WILBUR BUILDING
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94305
Practice Address - Country:US
Practice Address - Phone:650-736-5555
Practice Address - Fax:650-723-8378
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2014-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP12784363LF0000X
CA443865363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q13430Medicare UPIN
CAQ13430Medicare UPIN