Healthcare Provider Details

I. General information

NPI: 1609632629
Provider Name (Legal Business Name): DANIEL GOMEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2024
Last Update Date: 02/27/2024
Certification Date: 02/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 59TH ST N
ST PETERSBURG FL
33710-8539
US

IV. Provider business mailing address

10133 SHERRILL BLVD
KNOXVILLE TN
37932-3347
US

V. Phone/Fax

Practice location:
  • Phone: 727-345-2775
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number19746
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: