Individual
ALEXIS JHONATAN MAYA GOMEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
NP-C
Contact information
Practice address
5333 BALTIMORE DR APT 6, LA MESA, CA 91942-2085
(760) 886-2835
Mailing address
5333 BALTIMORE DR APT 6, LA MESA, CA 91942-2085
(760) 886-2835
Taxonomy
Speciality
Code
Description
License number
State
163WM0705X
Medical-Surgical Registered Nurse
786796
CA
363LF0000X
Family Nurse Practitioner
Primary
95008246
CA
Other
Enumeration date
12/16/2018
Last updated
12/17/2018
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