Provider Demographics
NPI:1992720486
Name:GOMEZ, ALMA E (PA)
Entity type:Individual
Prefix:
First Name:ALMA
Middle Name:E
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:ALMA
Other - Middle Name:
Other - Last Name:GOMEZ-VAN ALLMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3600 LIND AVE SW
Mailing Address - Street 2:SUITE 100 ATTN CREDENTIALING
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-4970
Mailing Address - Country:US
Mailing Address - Phone:425-690-2715
Mailing Address - Fax:
Practice Address - Street 1:3600 LIND AVE SW
Practice Address - Street 2:STE 170
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-4934
Practice Address - Country:US
Practice Address - Phone:425-656-5020
Practice Address - Fax:425-656-5019
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2020-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA60231468363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8925755OtherMEDICARE W VALLEY MEDICAL GROUP - RENTON
WA2015880Medicaid
MV0806729OtherDEA CERTIFICATE
VA970023455Medicare ID - Type UnspecifiedRAILROAD MEDICARE
VA970000556Medicare ID - Type Unspecified