Healthcare Provider Details

I. General information

NPI: 1346035565
Provider Name (Legal Business Name): FLAVIA ALEJANDRA GOMEZ MARIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2025
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7971 RIVIERA BLVD STE 203
MIRAMAR FL
33023-6446
US

IV. Provider business mailing address

3995 SW 108TH AVE APT 22
MIAMI FL
33165-4402
US

V. Phone/Fax

Practice location:
  • Phone: 786-508-3245
  • Fax: 561-634-2814
Mailing address:
  • Phone: 786-570-0106
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number929498
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: