WILSON GOMER M.D. PROFESSIONAL MEDICAL CORPORATION
NPI 1104327543
Clinic/Center - Health Service in San Bernardino, CA

Q: What is Wilson Gomer M.D. Professional Medical Corporation's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Health Service, with taxonomy code 261QH0100X.

Active since February 21, 2018

1800 WESTERN AVE STE 103, SAN BERNARDINO, CA 92411(909) 887-7427(909) 887-7430 Get Directions Write a Review

NPPES record last updated: June 6, 2018. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: Mar 17, 2018, Feb 21, 2018 (2 updates tracked since 2018).

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About Wilson Gomer M.d. Professional Medical Corporation NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

WILSON GOMER M.D. PROFESSIONAL MEDICAL CORPORATION (NPI 1104327543) is a healthcare organization registered as a health service in San Bernardino, California and active in the NPI registry since February 2018. The organization maintains a secondary practice location in Loma Linda and lists Wilson D Gomer, President, as its authorized official.

NPPES Registry Identity

NPI1104327543

Entity TypeOrganization

Primary Taxonomy261QH0100X

Legal Business NameWILSON GOMER M.D. PROFESSIONAL MEDICAL CORPORATION

Location Address1800 WESTERN AVE STE 103San Bernardino, CA 92411

Mailing Address1800 Western Ave Ste 103San Bernardino, CA 92411-1352 · (909) 887-7427 · Fax (909) 887-7430

Phone(909) 887-7427

Fax(909) 887-7430

Organization SubpartNo

Authorized OfficialWilson D GomerPresident · (909) 802-9374

Enumeration DateFebruary 21, 2018

Last NPPES UpdateJune 6, 20182 updates tracked since enumeration

✔ NPI 1104327543 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Health ServiceAmbulatory Health Care Facilities

Taxonomy Code261QH0100X

License✔ Licensed in CA · A50690

1800 WESTERN AVE STE 103, San Bernardino, CA 92411

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Secondary Practice Location 1

Location 111340 Mountain View Ave Ste BLoma Linda, CA 92354-3858 · Phone (909) 799-5445 · Fax (909) 799-2006

Other Identifiers 1

Medicaid00A506900CA

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 05D0889614

Wilson Gomer, MD Professional Medical Corp · San Bernardino, CA

Expired · Jul 31, 2026

CLIA Number05D0889614

Laboratory TypePhysician Office

Certificate Effective DateAugust 1, 2024

Certificate Expiration DateJuly 31, 2026

Laboratory DirectorWilson Gomer MD

Laboratory Phone(909) 887-7427

Laboratory LocationWilson Gomer, MD Professional Medical Corp1800 North Western Avenue Suite 103, San Bernardino, CA 92411

CLIA data matches this NPI record on: Phone

This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DORY LLAMADO GOMER

Nurse Practitioner

1800 WESTERN AVE STE 103
SAN BERNARDINO, CA 92411

San Bernardino County (909) 802-9374

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Wilson Gomer M.D. Professional Medical Corporation's NPI number?

The NPI number for Wilson Gomer M.D. Professional Medical Corporation is 1104327543. It was assigned to this organization in the NPPES registry on February 21, 2018.

Where is Wilson Gomer M.D. Professional Medical Corporation located?

Wilson Gomer M.D. Professional Medical Corporation is located at 1800 Western Ave Ste 103, San Bernardino, CA 92411. The listed phone number is (909) 887-7427.

What is Wilson Gomer M.D. Professional Medical Corporation's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Health Service, with taxonomy code 261QH0100X.

When was this NPI record last updated?

The NPPES record for Wilson Gomer M.D. Professional Medical Corporation was last updated on June 6, 2018. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.