Healthcare Provider Details

I. General information

NPI: 1205326055
Provider Name (Legal Business Name): XIOMARA GOMEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2018
Last Update Date: 02/26/2026
Certification Date: 02/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3140 NW 33RD ST
MIAMI FL
33142-5713
US

IV. Provider business mailing address

3140 NW 33RD ST
MIAMI FL
33142-5713
US

V. Phone/Fax

Practice location:
  • Phone: 786-316-8640
  • Fax:
Mailing address:
  • Phone: 786-316-8640
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: