Healthcare Provider Details

I. General information

NPI: 1295184497
Provider Name (Legal Business Name): OSCAR ANGEL GOMEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2016
Last Update Date: 06/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5220 BELFORT RD. SUIT 130
JACKSONVILLE FL
32256
US

IV. Provider business mailing address

22828 W. MOUL RD.
ELMWOOD IL
61529
US

V. Phone/Fax

Practice location:
  • Phone: 904-446-3760
  • Fax:
Mailing address:
  • Phone: 309-634-5235
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number209.013348
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: