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General NPI Number Information
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NPI Number | 1477264695
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Entity Type | Organization
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Legal Business Name | GOMEZ CLINIC CORP
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Dates
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Enumeration Date | 12/08/2022
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Last Update Date | 03/24/2025
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Provider Practice Location Address
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Address Line | 6583 SW 39TH TER STE B
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City | MIAMI
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State | FL
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Zip | 33155-4821
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Country | US
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Telephone | 786-747-4949
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Fax | 786-756-1010
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Provider Business Mailing Address
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Address Line | 6583 SW 39TH TER STE B
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City | MIAMI
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State | FL
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Zip | 33155-4821
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Country | US
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Telephone | 305-300-5551
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | ERIC CAMPILLO
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Credential | PMHNP
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Telephone | 305-300-5551
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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