Provider Demographics
NPI:1437594223
Name:GOMEZ, GREGORY VINCENT (MD)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:VINCENT
Last Name:GOMEZ
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 1:210 W SAN BERNARDINO RD
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91723-1515
Mailing Address - Country:US
Mailing Address - Phone:626-858-8580
Mailing Address - Fax:
Practice Address - Street 1:315 N 3RD AVE STE 302
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91723-1916
Practice Address - Country:US
Practice Address - Phone:626-332-1194
Practice Address - Fax:626-915-3162
Is Sole Proprietor?:No
Enumeration Date:2013-05-07
Last Update Date:2019-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA160904207X00000X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery