Healthcare Provider Details

I. General information

NPI: 1780720227
Provider Name (Legal Business Name): JOAQUIN A. GOMEZ, MD, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 07/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

2760 SW 97TH AVE #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 NumberME 75444
License Number StateFL

VIII. Authorized Official

Name: DR. JOAQUIN ALBERTO GOMEZ
Title or Position: PRESIDENT
Credential: M.D.
Phone: 305-228-7120