Healthcare Provider Details

I. General information

NPI: 1548814155
Provider Name (Legal Business Name): JUAN CAMILO GOMEZ MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2019
Last Update Date: 06/22/2020
Certification Date: 06/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 SW 37TH AVE STE 904
CORAL GABLES FL
33133-2751
US

IV. Provider business mailing address

2601 SW 37TH AVE STE 904
CORAL GABLES FL
33133-2751
US

V. Phone/Fax

Practice location:
  • Phone: 305-283-8375
  • Fax:
Mailing address:
  • Phone: 305-283-8375
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JUAN CAMILO GOMEZ
Title or Position: OWNER
Credential: MD
Phone: 305-283-8375