Organization Active NPI

Sergio R. Gomez M.D. Inc

  • Family Medicine Physician
  • Pomona, CA
National Provider Identifier
1134325822
Registry record updated May 31, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
A74276 Issued in CA
Legal business name
SERGIO R. GOMEZ M.D. INC
Practice address
2005 North Garey Ave
Pomona, CA 91767
Phone
(909) 868-1620
Fax
(909) 593-4500
NPI assigned
Jun 21, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 31, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Sergio Rene Gomez
Title
Medical President
Phone
(909) 868-1620

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X A74276 CA Primary

Addresses

Primary practice location

2005 North Garey Ave
Pomona, CA 91767

Mailing address

2005 N Garey Ave
Pomona, CA 91767-2721
Phone (909) 868-1620

Other identifiers 1

IdentifierTypeStateIssuer
00A742760MedicaidCA

National Provider Directory

National Provider Directory

Locations

2005 N Garey Ave
Pomona, CA 91767
Phone (909) 868-1620

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1182384000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1464652800000",
    "number": "1134325822",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2005 N GAREY AVE",
            "city": "POMONA",
            "state": "CA",
            "postal_code": "917672721",
            "telephone_number": "909-868-1620",
            "fax_number": "909-593-4500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2005 NORTH GAREY AVE",
            "city": "POMONA",
            "state": "CA",
            "postal_code": "91767",
            "telephone_number": "909-868-1620",
            "fax_number": "909-593-4500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SERGIO R. GOMEZ M.D. INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-21",
        "last_updated": "2016-05-31",
        "status": "A",
        "authorized_official_last_name": "GOMEZ",
        "authorized_official_first_name": "SERGIO",
        "authorized_official_middle_name": "RENE",
        "authorized_official_title_or_position": "MEDICAL PRESIDENT",
        "authorized_official_telephone_number": "909-868-1620"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A74276",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A742760",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pomona, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.