Healthcare Provider Details

I. General information

NPI: 1447366299
Provider Name (Legal Business Name): JOSE ALEJANDRO GOMEZ-RIVERA D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9485 SW 72ND ST A-104
MIAMI FL
33173-3242
US

IV. Provider business mailing address

9485 SW 72ND ST A-104
MIAMI FL
33173-3242
US

V. Phone/Fax

Practice location:
  • Phone: 305-270-1142
  • Fax: 305-270-1151
Mailing address:
  • Phone: 305-270-1142
  • Fax: 305-270-1151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS6658
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: