Healthcare Provider Details

I. General information

NPI: 1912467382
Provider Name (Legal Business Name): MAURICIO GOMEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2019
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2326 S CONGRESS AVE STE 1C
WEST PALM BEACH FL
33406-7652
US

IV. Provider business mailing address

2329 MERRIWEATHER WAY
WELLINGTON FL
33414-6430
US

V. Phone/Fax

Practice location:
  • Phone: 561-433-5577
  • Fax: 561-275-2696
Mailing address:
  • Phone: 954-224-0175
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME155875
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: