Active NPI
Mirtha Myreya Gomez, DDS
- Dentist
- San Diego, CA
National Provider Identifier
1124177761
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 50407
- Practice address
- 3544 30TH St
San Diego, CA 92104-4120 - Phone
- (619) 515-2424
- NPI assigned
- Jan 10, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 50407 | CA | Primary |
Addresses
Primary practice location
3544 30TH St
San Diego, CA 92104-4120
Mailing address
823 Gateway Center Way
San Diego, CA 92102-4541
Phone (619) 515-2323
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 50407 | Other | CA | LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160315001415 | CA | Order and Referring Only - Other (Physician) | 5890091094 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 50407 | CA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168387200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1508371200000",
"number": "1124177761",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "823 GATEWAY CENTER WAY",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921024541",
"telephone_number": "619-515-2323"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3544 30TH ST",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921044120",
"telephone_number": "619-515-2424"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOMEZ",
"first_name": "MIRTHA",
"middle_name": "MYREYA",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-01-10",
"last_updated": "2017-10-19",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "50407",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSE",
"identifier": "50407",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.