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General NPI Number Information
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NPI Number | 1518422906
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Entity Type | Individual
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Provider Name | PABLO ERASMO GOMEZ RUIZ SA-C
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Gender | Male
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Dates
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Enumeration Date | 02/10/2019
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Last Update Date | 05/05/2025
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Provider Practice Location Address
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Address Line | 9830 SW 55TH ST
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City | MIAMI
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State | FL
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Zip | 33165-7222
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Country | US
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Telephone | 956-701-5412
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Fax |
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Provider Business Mailing Address
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Address Line | 16521 SW 60TH TER
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City | MIAMI
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State | FL
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Zip | 33193-5705
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Country | US
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Telephone | 956-701-5412
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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 | 246ZC0007X
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Taxonomy Name | Surgical Assistant
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License Number | 16-226
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | APRN11039203
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License Number State | FL
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