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General NPI Number Information
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NPI Number | 1114662582
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Entity Type | Individual
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Provider Name | NICHOLAS GOMEZ
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Gender | Male
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Dates
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Enumeration Date | 05/01/2022
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Last Update Date | 11/11/2022
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Provider Practice Location Address
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Address Line | 14221 SW 120TH ST STE 214
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City | MIAMI
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State | FL
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Zip | 33186-4224
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Country | US
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Telephone | 786-452-1185
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Fax |
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Provider Business Mailing Address
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Address Line | 13370 SW 91ST TER UNIT A
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City | MIAMI
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State | FL
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Zip | 33186-1613
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Country | US
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Telephone | 305-778-9523
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT-22-204056
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License Number State | FL
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