MEDICARE: YAMILE DE LAS MERCEDES GOMEZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183700000X	Pharmacy Technician	RPT62	FL

General Provider Information

NPI Number	:	1366760290
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YAMILE DE LAS MERCEDES GOMEZ

Provider Business Mailing Address
First Line	:	4041 SW 96TH AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33165-5104
Country	:	US
Telephone Number	:	305-220-8822
Fax Number	:	305-220-8866

Provider Business Practice Location Address
First Line	:	4041 SW 96TH AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33165-5104
Country	:	US
Telephone Number	:	305-220-8822
Fax Number	:	305-220-8866

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/17/2010
Last Update Date	:	05/17/2010

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Directions to “ YAMILE DE LAS MERCEDES GOMEZ ” Practice Location

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