Provider Demographics
NPI:1386452084
Name:GARCIA, GARY RONALD GOMEZ (FNP-C)
Entity type:Individual
Prefix:
First Name:GARY RONALD
Middle Name:GOMEZ
Last Name:GARCIA
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:392 E STEVENS RD APT G15
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-4749
Mailing Address - Country:US
Mailing Address - Phone:760-673-6559
Mailing Address - Fax:
Practice Address - Street 1:392 E STEVENS RD APT G15
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-4749
Practice Address - Country:US
Practice Address - Phone:760-673-6559
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-27
Last Update Date:2024-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95033220363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily