Healthcare Provider Details

I. General information

NPI: 1184405862
Provider Name (Legal Business Name): ADRIAN QUINONES GOMEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2023
Last Update Date: 10/10/2023
Certification Date: 10/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9333 SW 152ND ST
PALMETTO BAY FL
33157-1778
US

IV. Provider business mailing address

1114 MICHAEL AVE
LEHIGH ACRES FL
33936-3200
US

V. Phone/Fax

Practice location:
  • Phone: 305-251-2500
  • Fax:
Mailing address:
  • Phone: 239-383-9443
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberHSE38864
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberHSE38864
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: