Healthcare Provider Details

I. General information

NPI: 1225097801
Provider Name (Legal Business Name): ISABEL CRISTINA GOMEZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2006
Last Update Date: 10/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1840 W 49TH ST SUITE # 517
HIALEAH FL
33012-2942
US

IV. Provider business mailing address

1840 W 49TH ST SUITE # 517
HIALEAH FL
33012-2942
US

V. Phone/Fax

Practice location:
  • Phone: 305-894-1164
  • Fax: 786-360-3867
Mailing address:
  • Phone: 305-894-1164
  • Fax: 786-360-3867

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME0044895
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: