Healthcare Provider Details

I. General information

NPI: 1780904581
Provider Name (Legal Business Name): HEYSU RUBIO-GOMEZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2010
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 NW 1ST ST
FORT LAUDERDALE FL
33311-8905
US

IV. Provider business mailing address

1608 SE 3RD AVE FL 3
FORT LAUDERDALE FL
33316-2564
US

V. Phone/Fax

Practice location:
  • Phone: 954-467-0880
  • Fax: 954-535-2030
Mailing address:
  • Phone: 954-467-0880
  • Fax: 954-535-2030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberME123657
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: