Healthcare Provider Details

I. General information

NPI: 1366217770
Provider Name (Legal Business Name): PAULA GOMEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2023
Last Update Date: 10/22/2024
Certification Date: 10/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 CURTISS PKWY
MIAMI SPRINGS FL
33166-5222
US

IV. Provider business mailing address

16244 SW 57TH LN
MIAMI FL
33193-2578
US

V. Phone/Fax

Practice location:
  • Phone: 786-355-6628
  • Fax:
Mailing address:
  • Phone: 786-355-6628
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0600X
TaxonomyGerontology Registered Nurse
License Number9487829
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11035721
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: