Basic Information
| Provider Information | |||||||||
| NPI: | 1588184055 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GOMEZ RINCON | ||||||||
| FirstName: | MARIANELA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5000 W SUNSET BLVD FL 4 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900275861 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3233612153 | ||||||||
| FaxNumber: | 3239538116 | ||||||||
| Practice Location | |||||||||
| Address1: | 5000 W SUNSET BLVD FL 4 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900275861 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3233612153 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2017 | ||||||||
| LastUpdateDate: | 01/14/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/14/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | A169505 | CA | N | Allopathic & Osteopathic Physicians | Pediatrics | 2080A0000X | A169505 | CA | Y | Allopathic & Osteopathic Physicians | Pediatrics | Adolescent Medicine |
No ID Information.