WILSON GOMER M.D. PROFESSIONAL MEDICAL CORPORATION NPI 1104327543

NPI Information

NPI: 1104327543
Provider Name: WILSON GOMER M.D. PROFESSIONAL MEDICAL CORPORATION
Classification: Clinic/Center - 261QH0100X
Entity Type: Organization

Specialization: Health Service

CLIA Number: 05D0889614

Address:
1800 WESTERN AVE STE 103
SAN BERNARDINO, CA
ZIP 92411
Phone: (909) 887-7427
Get Directions

WILSON GOMER M.D. PROFESSIONAL MEDICAL CORPORATION is a health service clinic center in San Bernardino, CA. WILSON GOMER M.D. PROFESSIONAL MEDICAL CORPORATION NPI is 1104327543. The provider is registered as an organization entity type.

The provider's business location address is:

1800 WESTERN AVE STE 103
SAN BERNARDINO, CA
ZIP 92411
Phone: (909) 887-7427
Fax: (909) 887-7430

The provider's authorized official is Wilson D Gomer .
The authorized official title is President and has the following contact phone number (909) 802-9374.

The CLIA number assigned to this NPI record is 05D0889614 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 2/21/2018 and was last updated on 6/6/2018.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QH0100X	Clinic/Center	Health Service	A50690	CALIFORNIA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	00A506900	MEDICAID	CALIFORNIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.

« Previous NPI

Next NPI »