Healthcare Provider Details

I. General information

NPI: 1548127053
Provider Name (Legal Business Name): EDUARDO GARCIA GOMEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2026
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17405 NW 94TH CT APT 307
HIALEAH FL
33018-4387
US

IV. Provider business mailing address

17405 NW 94TH CT APT 307
HIALEAH FL
33018-4387
US

V. Phone/Fax

Practice location:
  • Phone: 786-216-6829
  • Fax:
Mailing address:
  • Phone: 786-216-6829
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: