Healthcare Provider Details

I. General information

NPI: 1386370674
Provider Name (Legal Business Name): CAROLINA GOMEZ RODRIGUEZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2022
Last Update Date: 09/15/2022
Certification Date: 09/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 NW 12 AVENUE WEST WING
MIAMI FL
33136
US

IV. Provider business mailing address

1611 NW 12 AVENUE WEST WING 279, LC: R-109
MIAMI FL
33136
US

V. Phone/Fax

Practice location:
  • Phone: 305-585-8178
  • Fax: 305-585-5743
Mailing address:
  • Phone: 305-585-8178
  • Fax: 305-585-5743

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: