Provider Demographics
NPI:1346701455
Name:GOMEZ RUEDA, HUGO
Entity type:Individual
Prefix:
First Name:HUGO
Middle Name:
Last Name:GOMEZ RUEDA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2183 FAIRVIEW RD STE 211
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-5674
Mailing Address - Country:US
Mailing Address - Phone:949-567-8198
Mailing Address - Fax:949-567-8674
Practice Address - Street 1:2183 FAIRVIEW RD STE 211
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-5674
Practice Address - Country:US
Practice Address - Phone:949-567-8198
Practice Address - Fax:949-567-8674
Is Sole Proprietor?:No
Enumeration Date:2019-03-29
Last Update Date:2025-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1766012084P0800X
NMMD2021-08282084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty