Healthcare Provider Details

I. General information

NPI: 1386900637
Provider Name (Legal Business Name): CAMILO ANDRES GOMEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2012
Last Update Date: 11/12/2020
Certification Date: 11/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 NW 12TH AVE # 3019
MIAMI FL
33136-1005
US

IV. Provider business mailing address

1611 NW 12TH AVE # 3019
MIAMI FL
33136-1005
US

V. Phone/Fax

Practice location:
  • Phone: 305-585-5215
  • Fax:
Mailing address:
  • Phone: 305-490-3367
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberME146571
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberME146571
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: