MEDICARE: PAOLA CATALINA OSSA 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	122300000X	Dentist	DN21589	FL

General Provider Information

NPI Number	:	1639513450
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAOLA CATALINA OSSA GOMEZ

Provider Business Mailing Address
First Line	:	5945 SW 134TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33156-7207
Country	:	US
Telephone Number	:	305-332-8575
Fax Number	:

Provider Business Practice Location Address
First Line	:	5945 SW 134TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33156-7207
Country	:	US
Telephone Number	:	305-332-8575
Fax Number	:

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

Provider Enumeration Date	:	04/23/2013
Last Update Date	:	09/17/2015

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