Healthcare Provider Details

I. General information

NPI: 1538350848
Provider Name (Legal Business Name): OMAR GOMEZ-MEDINA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2007
Last Update Date: 02/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ID14 CALLE ALMACIGO EXT. ROYAL PALM
BAYAMON PR
00956-3104
US

IV. Provider business mailing address

658 CALLE MIRAMAR APT 1201
SAN JUAN PR
00907-3450
US

V. Phone/Fax

Practice location:
  • Phone: 787-288-0808
  • Fax: 787-288-0888
Mailing address:
  • Phone: 787-640-5362
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number17595
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code2081N0008X
TaxonomyNeuromuscular Medicine (Physical Medicine & Rehabilitation) Physician
License Number17595
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: