Healthcare Provider Details

I. General information

NPI: 1508854852
Provider Name (Legal Business Name): CESAR GERARDO GOMEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

#4ES-12 AVE. FRAGOSO VILLA FONTANA
CAROILINA PR
00983
US

IV. Provider business mailing address

35 JC BORBON STE 67 PMB 353
GUAYNABO PR
00969-5375
US

V. Phone/Fax

Practice location:
  • Phone: 787-276-7006
  • Fax: 787-276-7030
Mailing address:
  • Phone: 787-630-0563
  • Fax: 787-439-2154

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number15786
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: