Healthcare Provider Details

I. General information

NPI: 1114843828
Provider Name (Legal Business Name): BLANCA GOMEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2026
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 NW 20TH ST
MIAMI FL
33127-4622
US

IV. Provider business mailing address

635 NE 9TH PL
HOMESTEAD FL
33030-4925
US

V. Phone/Fax

Practice location:
  • Phone: 305-237-4141
  • Fax:
Mailing address:
  • Phone: 786-765-6031
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: