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General NPI Number Information
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NPI Number | 1003169400
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Entity Type | Individual
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Provider Name | MR. JULIO A GOMEZ DE MELLO
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Gender | Male
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Dates
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Enumeration Date | 10/23/2012
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Last Update Date | 10/23/2012
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Provider Practice Location Address
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Address Line | 928 W 67TH ST
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City | HIALEAH
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State | FL
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Zip | 33012-6467
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Country | US
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Telephone | 305-965-6098
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Fax |
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Provider Business Mailing Address
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Address Line | 928 W 67TH ST
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City | HIALEAH
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State | FL
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Zip | 33012-6467
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Country | US
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Telephone | 305-965-6098
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | MA-64739
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License Number State | FL
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