Healthcare Provider Details

I. General information

NPI: 1750553160
Provider Name (Legal Business Name): GOMEZCARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2008
Last Update Date: 08/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4217 BAYMEADOWS RD SUITE #3
JACKSONVILLE FL
32217-4676
US

IV. Provider business mailing address

4217 BAYMEADOWS RD SUITE#3
JACKSONVILLE FL
32217-4676
US

V. Phone/Fax

Practice location:
  • Phone: 904-332-7431
  • Fax: 904-332-7408
Mailing address:
  • Phone: 904-332-7431
  • Fax: 904-332-7408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License NumberME 37948
License Number StateFL

VIII. Authorized Official

Name: JOSE MARIA GOMEZ
Title or Position: PRESIDENT-OWNER
Credential: M.D.
Phone: 904-332-7431