Individual
VICTOR ANSELMO GOMEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
2728 SUNSET BLVD STE 400, WEST COLUMBIA, SC 29169-4839
(803) 936-7095
(803) 936-7908
Mailing address
PO BOX 6069, WEST COLUMBIA, SC 29171-6069
(803) 936-7095
(803) 936-7908
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
0010-01821
NC
363A00000X
Physician Assistant
13134
GA
363A00000X
Physician Assistant
Primary
607
SC
363AS0400X
Surgical Physician Assistant
607
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0012PA
—
SC
05
—
003331378A
—
GA
05
—
003331378B
—
GA
Enumeration date
05/03/2006
Last updated
07/22/2026
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