Healthcare Provider Details

I. General information

NPI: 1407509789
Provider Name (Legal Business Name): ALBERTO GOMEZ PEREZ R.T.(R)(CT)(ARRT)
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2022
Last Update Date: 11/12/2025
Certification Date: 11/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

365 NW 190TH ST
MIAMI GARDENS FL
33169-3904
US

IV. Provider business mailing address

365 NW 190TH ST
MIAMI GARDENS FL
33169-3904
US

V. Phone/Fax

Practice location:
  • Phone: 783-339-7824
  • Fax: 305-907-5343
Mailing address:
  • Phone: 783-339-7824
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2471C3401X
TaxonomyComputed Tomography Radiologic Technologist
License NumberCRT95545
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2471C3402X
TaxonomyRadiography Radiologic Technologist
License NumberCRT95545
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: