MEDICARE: JORGE D GOMEZ CHIANG IMH27926

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	251B00000X	Case Management Agency	CBHCMS0101215	FL
2	104100000X	Social Worker	CBHCMS0101215	FL
3	101YM0800X	Mental Health Counselor	IMH27926	FL
4	171M00000X	Case Manager/Care Coordinator	CBHCMS.0101215	FL

General Provider Information

NPI Number	:	1952892838
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORGE D GOMEZ CHIANG IMH27926

Provider Business Mailing Address
First Line	:	6256 SW 136TH CT APT E105
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33183-5037
Country	:	US
Telephone Number	:	786-805-1897
Fax Number	:

Provider Business Practice Location Address
First Line	:	6256 SW 136TH CT APT E105
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33183-5037
Country	:	US
Telephone Number	:	786-805-1897
Fax Number	:

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

Provider Enumeration Date	:	05/25/2018
Last Update Date	:	04/09/2026

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