Healthcare Provider Details

I. General information

NPI: 1295742815
Provider Name (Legal Business Name): JOAQUIN A. GOMEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 09/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2760 SW 97TH AVE SUITE 105
MIAMI FL
33165-2684
US

IV. Provider business mailing address

2760 SW 97TH AVE SUITE 105
MIAMI FL
33165-2684
US

V. Phone/Fax

Practice location:
  • Phone: 305-228-7120
  • Fax: 305-228-6153
Mailing address:
  • Phone: 305-228-7120
  • Fax: 305-228-6153

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME75444
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: