Provider Demographics
NPI:1699959445
Name:GOMEZ, ERICA OLYMPIA (PA-C)
Entity type:Individual
Prefix:MS
First Name:ERICA
Middle Name:OLYMPIA
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:18335 E VALLEY BLVD
Mailing Address - Street 2:
Mailing Address - City:LA PUENTE
Mailing Address - State:CA
Mailing Address - Zip Code:91744-5968
Mailing Address - Country:US
Mailing Address - Phone:626-810-3330
Mailing Address - Fax:626-964-0440
Practice Address - Street 1:18335 E VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:LA PUENTE
Practice Address - State:CA
Practice Address - Zip Code:91744-5968
Practice Address - Country:US
Practice Address - Phone:626-810-3330
Practice Address - Fax:626-964-0440
Is Sole Proprietor?:No
Enumeration Date:2007-12-28
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA19481363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant